AC 4373 GRE 29 THE ANNUAL REPORT made to THE COUNCIL of the Metropolitan Borough of Greenwich For the Year 1928, by ERNEST GEORGE ANNIS, M.R.C.S., L.R.C.P., L.S.A., D.P.H., Barrister-at-Law. Fellow of the Royal Sanitary Institute. Fellow of the Royal Institute of Public Health. Fellow of the Institute of Hygiene. MEDICAL OFFICER OF HEALTH TO THE BOROUGH ADMINISTRATIVE MATERNITY AND CHILD WELFARE MEDICAL OFFICER, and EXECUTIVE TUBERCULOSIS OFFICER. London: FREAME, MANNING & CO., LTD., 12a, Lee High Road, S.E.13. 1929. THE ANNUAL REPORT made to THE COUNCIL of the Metropolitan Borough of Greenwich For the Year 1928, by ERNEST GEORGE ANNIS, M.R.C.S., L.R.C.P., L.S.A., D.P.H., Barrister-at-Law. Fellow of the Royal Sanitary Institute. Fellow of the Royal Institute of Public Health. Fellow of the Institute of Hygiene. MEDICAL OFFICER OF HEALTH TO THE BOROUGH ADMINISTRATIVE MATERNITY AND CHILD WELFARE MEDICAL OFFICER, and EXECUTIVE TUBERCULOSIS OFFICER. London: FREAME, MANNING & CO., LTD., 12a, Lee High Road, S.E.13. 1929. CONTENTS. Pages Public Health Committee 1-2 Maternity and Child Welfare Committee 3 Introductory 4-7 Section I.—Natural and Social Conditions of the Area 8 Vital Statistics 9-20 „ II.—General Provisions of Health Services in the Area 21-29 Laboratory Work 26 „ III.—Sanitary Circumstances of the Area 30-43 „ IV.—Housing 44-40 „ V.—Inspection and Supervision of Food 47-56 „ VI.—Prevalence of, and Control Over, Infectious Diseases 57-81 „ VII.—Maternity and Child Welfare 82-93 1 Public Health Committee during the year, 1927-8. The Mayor- Alderman R. F. A. Purkiss, J.P., and 13 Members. Alderman W. O. Willis, K.C. Councillors— M. G. Byerley, F.R.C.V.S., J.P. (Chairman). F. Winchcomee (Vice-Chairman) Mrs. P. M. Beacham Mrs. S. H. Mills Mrs. F. Carter Mrs. C. H. Thackeray H. C. Gallehawk Mrs. C. R. Turner, J.P. H. H. Gibbons Mrs. M. Woolner Major R. H. Green Dr. W. R. Hodgkinson, C.B.E., M.A. Powers and Duties of the Public Health Committee— 1.— The Committee shall consist of thirteen elected members. There shall be referred to the Committee the execution of the Food and Drugs Act, 1875-1899; the Margarine Act, 1887; the sale of Horseflesh, etc., Regulation Act, 1889; such matters arising under the Housing of the Working Classes Acts, 1890 and 1894, and the Working Classes Dwellings Act, 1890; Housing and Town Planning Acts; the Public Health (London) Acts; the Metropolis Management Acts relating to defective drainage; the Canal Boat Acts; the Factory and Workshop Acts; Increase of Rent and Mortgage Interest Restrictions Acts, 1920 and 1923; the sanitary provisions of any other Act of Parliament: the Rats and Mice (Destruction) Act, 1919; the powers of the Council under the Orders of the Local Government Board or Ministry of Health dealing with Tuberculosis; and the Milk (Special Designations) Order, 1923; the by-laws and regulations made under the above Acts, or otherwise relating to the public health and sanitary condition of the Borough, as are not within the reference to any other Committee. 3.—The Committee may serve and receive notices, take proceedings, and in particular cases empower any Officer of the Council to make complaints and take proceedings in their behalf under, and otherwise execute, the Public Health 2 (London) Act, 1891, and sections 82, 83, 84 and 85 of the Metropolis Management Act, 1855, relating to the inspection of any premises, drains, sinks, traps, syphons, pipes, or other works or apparatus connected therewith, and otherwise in relation to defective drainage, except as to the recovery of expenses, and the same shall not require the approval of the Council. Provided that the Committee shall report their action to the next following meeting of the Council, who may at any time determine or prohibit or otherwise vary any such notices or proceedings. 4.—All plans for drainage and re-drainage of premises shall be laid before the Committee for consideration. 5.—Works of drainage of houses and premises shall be carried out under the direction of this Committee. G.—The Committee shall have the control of Mortuaries erected or maintained by the Council, as the Sanitary Authority, and shall have control of the disinfecting stall, apparatus and plant. 7.—The construction, maintenance and control of public sanitary conveniences, and conveniences maintained by the Council, shall be referred to this Committee. 8.—Provision and maintenance of Tuberculosis Dispensary. Additional matters coming within the definition of the sanitary provisions of any other Act of Parliament:- Notification of Births Act, 1907. Housing and Town Planning Act, 1909, 1919. Housing, &c., Act, 1923. London County Council (General Powers) Act, 1902, 1907, 1908, 1922, 1927, 1928. Rag Flock Act, 1911. Public Health (Tuberculosis Regulations), 1912. Rats and Mice (Destruction) Act, 1919. Rent and Mortgage Interest Restrictions Acts, 1920 and 1923. Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies (Amendment) Act, 1922. Milk and Dairies Order, 1926. Public Health (Condensed Milk) Regulations, 1923. „ „ (Dried Milk) „ „ „ ,, (Meat) Regulations, 1924. „ ,, (Imported Milk) Regulations, 1926. ,, ,, (Preservatives, &c., in Food) Regulations. „ ,, (Smoke Abatement) Act, 1926. 3 Maternity and Child Welfare Committee during the Year 1927-8. The Mayor— Alderman R. F. A. Purkiss, J.P., and 14 Members. Councillors - *Mrs. M. Woolner (Chairman) *Miss M. Sherman (V ice-Chairman) *Mrs. P. M. Beacham *Mrs. F. Carter *Mrs. N. Cunis M. C. Matthews, M.A. *Mrs. S. H. Mills Col. A. C. Ralph, D.S.O. *Mrs. C. H. Thackeray *Mrs. C. R. Turner, J.P. Co-opted Members— *Mrs. E. C. Berry *Miss C. H. Hervey *Mrs. L. M. Jones *Mrs. S. Pridden *Denotes Members who served on The Assistance Sub-Committee. Powers and Duties of the Maternity and Child Welfare Committee. 1.—The Committee shall consist of 14 members, 10 of whom shall be members of the Council, and four selected by the Council from outside that Body. 2.—There shall be referred to the Committee all matters arising out of the powers and duties of the Council under the Maternity and Child Welfare Act, 1918, or any Act or Acts amending the same, or of any Orders or Regulations made under such Act or Acts, and the Committee shall make recommendations to the Council in relation to the matters aforesaid. 4 Public Health Offices, Borough Hall, Royal Hill, Greenwich, S.E.10. May, 1929. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Ladies and Gentlemen, I have the honour to submit herewith the Annual Report as Medical Officer of Health for the year 1928. The Death-Rate is 11.13 per 1,000 of the estimated population. This is .30 higher than the average for the previous five years, and compares favourably with the rates for the County of London and England and Wales, which are returned at 11.6 and 11.7 respectively. Whilst the Death-Rate is a fraction higher than last year, it must be remembered that the 1927 period was an exceptionally healthy year, and had it not been for the unfortunate outbreak of Measles during the first half of the year under review, which accounted for no less than 25 deaths, the Death-Rate would have been appreciably lower. The Birth-Rate is 16.42 per 1,000, and is slightly higher than the low figure recorded last year, which was 16.27. The average for the last ten years is 19.75. The Birth-Rate for the County of London is 15.9, and 16.7 for all England and Wales. 5 The Infant Mortality Rate for the Borough, measured by the number of deaths in the one year to 1,000 births registered, is 55, compared with 53 last year. The Rates in the various Metropolitan Boroughs varied from 48 in Chelsea, 50 in Woolwich, 52 in Lewisham, and 54 in Hampstead, up to 77 in Fulham and St. Marylebone, 78 in Bermondsey, 83 in Finsbury, 84 in Paddington, and 86 in Kensington. The rate for England and Wales is 65, and for the County of London 67. The Zymotic Death-Rate of .59 per 1,000 is slightly higher than last year's figure of .36. The figures relating to the different constituent parts of the Borough are as follows:- Districts Birth Rate Death Rate Infantile Mortality per 1000 Births. Zymotic Death Rate Diarrhcea and Enteritis Death Rate (under 2 yrs.) Consumption Death Rate East Greenwich 16.04 11.03 60 .60 .06 .92 West Greenwich 14.12 12.10 78 .63 .18 1.19 St. Nicholas, Deptford 23.44 11.50 40 .94 .13 1.21 Charlton 17.25 10.37 35 .50 .04 1.20 Kidbrooke 13.62 8.82 - - - - Whole Borough 16.42 11.13 55 .59 .96 1.03 Attack Rates of the various notifiable diseases per 1,000 living in the several districts are as follows:- Districts Small-pox Diphtheria Scarlet Fever Erysipelas Typhoid Fever Puerperal Fever per 1,000 Births) East Greenwich 0.00 4.80 3.87 .70 .11 - West Greenwich 0.00 3.35 3.21 .18 .22 7.38 St. Nicholas, Deptford 0.00 7. 03 5.54 1.89 - - Charlton 0.00 4.72 3.05 .55 - 5.48 Kidbroolce 0.00 2.76 3.64 .30 .30 - Whole Borough 0.00 4.46 3.58 .69 .11 2.93 6 In conclusion, it is my privilege again to express my appreciation of the kindness and consideration which has always been shown to me by the members of the Public Health, and Maternity and Child Welfare Committees, and the whole of the members of the Council. I gladly acknowledge also the valuable support I have at all times received from every member of my capable and enthusiastic Staff, and particularly the voluntary workers of the various Maternity and Child Welfare Centres. I am, Ladies and Gentlemen, Your obedient Servant, E. G. Annis. The Thames Flood, January, 1928. During the night of Saturday, 7th January, 1928, the Thames rose to a height of 18-ft. 5-in. above datum line, the highest previously recorded tide being 17-ft. 6-in. in January, 1881, and February, 1884, with the result that a considerable portion of the Borough adjacent to the River Bank was flooded in many cases to a depth of several feet. Happily in Greenwich, no cases can be recorded of persons having been drowned whilst sleeping in basements, as occurred in some other Boroughs, but the sudden inundation of flood water occasioned a very considerable amount of damage both to house property, furniture, bedding, etc. The areas affected were promptly visited by His Worship the Mayor (Alderman R. F. A. Purkiss, J.P.), in company with the Town Clerk, Borough Engineer and the Medical Officer of Health, relief first being in the form of coal in order to assist in drying out the soaked walls and floors. Four cwts. of coal were eventually distributed to each house affected. It was at once appreciated that a very great amount of detail work would be necessary in order to deal adequately with 7 claims for damage caused by the floods, and it was decided that the Public Health Department, with its outdoor staff of Sanitary Inspectors and Health Visitors, and its inside administrative organisation, was the Department of the Council best qualified and equipped to deal with the matter. As soon as possible every house affected by the floods was visited and particulars taken as to the amount of damage sustained. There was a liberal response to the Fund established by His Worship the Mayor in aid of the flood sufferers and financial help was also forthcoming from the Central Fund organized by the Lord Mayor of London. A total of £2,330 3s. 6d. was spent in affording relief, as follows :— £ s. d. Coal 262 2 6 Boots and hose 265 19 3 Bedding, blankets, sheets 58 3 3 Mats and rugs 192 7 0 Linoleum 916 13 3 Pianos 172 10 0 Furniture 307 1 6 Disinfectants 76 9 10 Other items 78 16 11 *£2,330 3 6 The number of premises actually affected by the floods totalled more than 600, the areas principally concerned being East Street, West Street, North Street, Hardens Manor Way in the Charlton district, Grove Street, Butcher's Row, The Stowage, Thames Street, Little Thames Street, Wood Wharf, King William Street in the St. Nicholas and West Wards, and Eastney Street, Ordnance Road, River Bank, Crane Street and High Bridge in the East district. I feel that a word of praise is due to the members of my Staff who in addition to their ordinary duties, were suddenly called upon to take over the large amount of extra work occasioned by the floods. Every application for assistance received very careful consideration, and it was not until the end of April that it was found possible to close the flood fund. 8 SECTION 1. NATURAL AND SOCIAL CONDITIONS OF THE AREA. General Statistics. Elevation—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton and Kidbrooke 1,991 „ 3,859 acres Population— At Census, 1921 100,450 Estimated, 1928 103,900 Density of Population— East Greenwich 34.18 persons per acre West Greenwich 59.48 ,, St. Nicholas, Deptford 64.79 ,, Charlton and Kidbrooke 12.58 ,, Average for the Borough 26.92 persons per acre Number of Inhabited Houses- Structurally separate dwellings at Census, 1921 16,536 1928 18,232 Number of Uninhabited Houses— At Census, 1921 288 Estimated, 1928 103 Number of Families or Separate Occupiers— At Census, 1921 22,972 Rateable Value £891,246 Sum Represented by a 1d. Rate £3,345. 9 VITAL AND MORTAL STATISTICS, 1928. POPULATION. The population of the Borough estimated to the middle of the year 1928 is 103,450 for the Death-Rate and 103,900 for the Birth-Rate. Slight adjustments have been made in regard to the local population figures. In the St. Nicholas district, owing to the Watergate Street Area Clearance Scheme, 109 families, representing 530 persons, have been displaced. Sixty-six families migrated to other Boroughs and 43 were re-housed in different parts of the Borough. Also, from information received from the Housing Department, certain alterations have been made due to the movements of families from other districts of the Borough to the Charlton district, in which area the Council's Housing Estate is situate. Just at the moment of going to press, the Registrar-General has sent for the Guidance of Local Authorities, estimates of population for last year. His figures are 100,200 for DeathRate and 101,200 for Birth-Rate, and are a considerable reduction on those furnished last year. It may be recollected that even then I considered such figures to be too low. The following is the distribution of the population throughout the Borough and upon which the statistics in this Report are based :- Census 19*21 (Adjusted) Estimated Population at middle of year 1928. For Death Kate. For Birth Rate. East Greenwich 44,647 44,250 44,445 West Greenwich 26,931 26,828 26,946 St. Nicholas, Deptford 7,646 7,419 7,461 Charlton 18,959 21,653 21,744 Kidbrooke 3,217 3,300 3,314 Total 101,400 103,450 103,900 10 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. *Births Legitimate 1,645 787 858 *Birth Rate 16·7 Illegitimate 67 38 29 *Deaths 1,159 603 556 *Death Rate 11·3 *Number of women dying in, or in consequence of, childbirth From Sepsis 2 ,, other causes 6 *Deaths of Infants under one year of age per 1,000 births: — Legitimate, 53 ; Illegitimate, 119. Total Rate = 56. *Deaths from Measles (all ages) 26 „ ,, Whooping Cough (all ages) 8 ,, ,, Diarrhoea (under 2 years of age) 12 *These figures, which are supplied by the Registrar-General, differ slightly from those shown in other parts of the Report. MARRIAGES. The Superintendent-Registrar of the Greenwich Registration District has kindly furnished me with the particulars relating to the number of marriages solemnised in the Parishes of Greenwich and St. Nicholas. The Superintendent-Registrar for the Woolwich Registration District has also kindly supplied the particulars for the parish of Charlton and Kidbrooke, with the exception, in these latter particulars, that the marriages performed in the Woolwich Superintendent-Registrar's Office of residents in that Parish are not included. The following table shows these particulars, giving the number of marriages in Greenwich and St. Nicholas, etc., for each year since 1914:— Year In Churches of England in Greenwich Charlton & Kidbrooke St. Nicholas Parish Church Marriages in Superintendent-Registrar's Office of parties resident in Greenwich or outside the Registration District, and in Chapels and Roman Catholic Church in St. Nicholas & Greenwich Total Approximate Population of the districts concerned In Churches of England In Non-Conformist Churches 1914 279 135 — 72 243 729 96037 1915 472 188 — 95 406 1161 96385 1916 381 145 — 74 324 924 94452 1917 343 128 — 67 653 1191 90446 1918 353 165 — 55 214 817 89939 1919 419 197 — 76 326 1018 102591 1920 384 105 — 64 322 875 104453 1921 344 124 — 57 249 774 100493 1922 364 112 — 45 275 796 101930 1923 336 132 — 51 222 741 102460 1924 299 127 10 55 200 691 102990 1925 265 132 5 48 224 674 103520 1926 382 95 11 48 260 796 104500 1927 388 91 6 45 233 763 103700 1928 356 84 3 52 243 738 103900 11 BIRTHS. The total number of births registered in the Borough during the year was 1,939. Of this number 367 occurred in Greenwich, and Deptford Hospital and 437 at various Nursing Homes within the Borough. Of this total of 802 Institution births, 406 only belonged to Greenwich, the remainder being transferred to the appropriate localities. One hundred and sixty births belonging to the Borough) took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 1,701:—Males, 813; Females, 888. This figure gives a Birth Rate of 16.42 per 1,000 of the population, which is 3.33 below the average for the last ten years. The Birth Rate for the County of London equals 15.9 per 1,000 of the population. The Birth Rate for all England and Wales was 16.7 and 16.9 for the 107 large towns. Illegitimate births numbered 62, representing 3.6 percent. of the total births. Seventy-three illegitimate births actually were registered in the Borough. In 33 cases, however, the mothers were ordinarily resident outside the Borough, and these births were consequently allocated to the correct area. 22 illegitimate births belonging to Greenwich occurred outside the Borough, thus giving the net figure of 62. Thirty-six illegitimate births occurred in the Greenwich) and Deptford Hospital. Under the Births and Deaths Registration Act, 1926, which came into operation on the 1st July, 1927, the registration of stillbirths became compulsory. 49 such stillbirths were registered during the year, representing a percentage of 2.2 of the total births registered. Each of such cases is separately investigated with a view to finding out whether what is thought to have been the cause for such stillbirth is of a preventable nature, and if so, an endeavour is made to take such appropriate action as will guard against a recurrence of this condition. Under the provisions of the Notification of Births Act, 1907, intimations have been received from medical men, parents and others, with respect to 2,063 births; 71 were in respect of stillbirths, of which number 22 were referred to other Boroughs. 12 DEATHS. The nett number of deaths registered during 1928 was 1,148, of which 597 were males and 551 females. The crude Death, Rate for the Borough, 11.13 per 1.000, is only .30 higher than the low figure recorded last year and compares favourably with 11.6, the Death Rate for the County of London and the 107 large towns. The following table showing causes of death at all ages has been supplied by the Registrar-General, and is included in accordance with the request contained in the Ministry of Health's Circular No. 834. It should be mentioned that the Table refers to deaths during the calendar year, whereas the Tables appearing in the Appendix of this Report relate to the weekly Returns furnished by the local Registrars. Causes of Death. Sex. Deaths at Subjoined ages of "Residents," whether occuring within or without the District. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and under 75. 75 and over. All Causes M 603 60 24 15 12 38 64 171 112 107 F 556 36 18 14 13 35 47 134 110 149 Enteric Fever M 1 ... ... ... ... ... 1 ... ... ... F 1 ... ... ... ... 1 ... ... ... ... Small-Pox M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... Measles M 13 ... 7 6 ... ... ... ... ... ... F 13 2 5 5 1 ... ... ... ... ... Scarlet Fever M ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... ... Whooping Cough M 3 1 2 ... ... ... ... ... ... ... F 5 2 2 ... 1 ... ... ... ... ... Diphtheria M 10 4 2 2 l ... ... 1 ... ... F 5 1 ... 2 2 ... ... ... ... ... Influenza M 8 ... ... ... 1 2 ... 4 ... 1 F 5 ... ... ... ... ... ... 2 2 1 Encephalitis Lethargica M 2 ... ... 1 ... ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System M 63 ... ... 1 ... 15 20 21 5 ... F 45 ... ... ... 1 19 12 12 1 ... Other Tuberculous Diseases M 8 ... 2 1 2 1 1 1 ... ... F 5 ... 1 1 1 ... 2 ... ... ... Cancer, malignant disease M 70 ... ... ... ... ... 3 29 23 15 F 74 ... ... ... ... 1 2 35 22 14 Rheumatic Fever M ... ... ... ... ... ... ... ... ... ... F 6 ... ... ... 2 3 1 ... ... ... Diabetes M 3 ... ... ... ... ... ... 1 1 1 F 8 ... ... ... ... ... ... 3 ... 5 Cerebral Haemorrhage, &c. M 15 ... ... ... ... ... 1 4 7 3 F 43 ... ... ... ... ... ... 13 13 17 Heart Disease M 105 ... ... ... 1 2 5 41 25 31 F 91 ... ... ... ... 1 6 23 32 29 Arterio-Sclerosis M 44 ... ... ... ... ... ... 14 13 17 F 22 ... ... ... ... ... ... 3 5 14 Bronchitis M 16 1 ... ... ... ... 1 1 6 7 F 29 3 3 ... ... ... l 1 5 16 Pneumonia (all forms) M 49 13 5 ... ... 1 10 9 11 ... F 26 4 3 5 ... 2 l 4 3 4 Other Respiratory Diseases M 6 ... ... ... ... ... ... 4 ... 2 F 9 1 ... ... ... 1 l 2 ... 4 Ulcer of Stomach Duodenum M 8 ... ... ... ... ... 3 4 1 ... F 6 ... ... ... ... ... 1 4 1 ... Diarrhœa, &c. M 8 7 1 ... ... ... ... ... ... ... F 6 3 1 ... ... ... 1 1 ... ... Appendicitis M 4 ... ... ... 1 2 ... ... ... 1 F 3 ... ... ... ... 1 1 1 ... ... Cirrhosis of Liver M 4 ... ... ... ... ... ... 2 1 1 F 3 ... ... ... ... ... ... 1 1 1 A. & Cr. Nephritis M 21 ... ... 1 ... 3 1 8 4 3 F 17 ... ... ... ... 1 2 5 6 3 Puerperal Sepsis M ... ... ... ... ... ... ... ... ... ... F 3 ... ... ... ... 3 ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition. M ... ... ... ... ... ... ... ... ... ... F 4 ... ... ... ... 1 3 ... ... ... Congenital Debility and Malformation, including Premature Birth M 18 18 ... ... ... ... ... ... ... ... F 17 17 ... ... ... ... ... ... ... ... Suicides M 4 ... ... ... ... ... 2 2 ... ... F 2 ... ... ... ... ... ... 2 ... ... Other Deaths from Violence M 31 5 2 1 2 8 5 3 2 3 Other Defined Diseases F 19 1 1 l 1 1 ... 1 7 6 M 89 11 9 2 3 4 11 21 18 22 F 88 2 2 ... 3 3 10 21 12 35 Diseases ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 13 14 The following table which is compiled by the RegistrarGeneral shows at a glance the relative position occupied by Greenwich with other Boroughs in London: — Borough. Rate per 1000 population Borough. Rate per 1000 Population. Lewisham 10·3 St. Marylebone 11·6 City of Westminster 10·7 Deptford 11·7 Woolwich 10·7 Lambeth 11·7 Fulham 10·8 Stoke Newington 11·8 Wandsworth 10·8 St. Pancras 12·1 Greenwich 11·0 Holborn 12·3 Bethnal Green 11·0 Islington 12·3 Camberwell 11·2 Bermondsey 12·4 Hackney 11·2 Southwark 12·5 Battersea 11·3 Kensington 12·7 Hampstead 11·3 Paddington 12·8 Poplar 11·3 Shorcditch 12·8 Hammersmith 11·4 Chelsea 13·2 Stepney 11·4 Finsbury 14·1 Locally the Death Rate varied from 8.82 in Kidbrooke, 10.37 in Charlton, 11.03 in, East Greenwich, 11.50 in St. Nicholas, Deptford, up to 12.10 in West Greenwich. Of the total number of deaths, 11 under five years of age were of illegitimate birth, 6 of whom were under one year of age. The following table shows the variation in, and average of the Death Rates in each of the five Districts of the Borough in the five years 1923 to 1927 compared with the figures for 1928. District. 1923 1924 1925 1926 1927 Average for 5 years. 1928 East Greenwich 10.43 11.14 10.87 10.82 10.59 10.77 11.03 West Greenwich 12.97 11.84 12.45 12.24 11.48 12.19 12.10 St. Nicholas, Deptford 12.58 11.77 12.63 14.22 11.11 12.46 11.50 Charlton 8.74 12.41 11.36 8.89 10.66 10.41 10.37 Kidbrooke 10.47 6.61 6.09 5.45 9.16 7.55 8.82 Borough 10.95 11.47 11.36 10.89 10.83 11.10 11.13 15 DEATHS IN INSTITUTIONS. The following table shows the number of deaths of Greenwich residents in Public Institutions during the last six years: — Year Total Deaths of Greenwich Residents Total Deaths of Greenwich Residents in Public Institutions 1923 1,119 546 1924 1,200 565 1925 1,173 621 1926 1,130 600 1927 1,115 607 1928 1,148 616 Average 1,147 592 AGE MORTALITY. The age mortality and the distribution of the deaths between the different quarters of the year is shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 30 26 17 22 95 Between 1 and 2 years 10 15 7 10 42 Between 2 and 5 years 10 13 4 2 29 Between 5 and 15 years 7 6 6 7 26 Between 15 and 25 years 20 27 12 14 73 Between 25 and 45 years 19 28 23 37 107 Between 45 and 65 years 95 61 71 78 305 65 years and upwards 144 115 93 119 471 Total 335 291 233 289 1,148 16 INFANTILE MORTALITY. The Infantile Mortality Rate measured by the deaths of children under one year of age to the number of births registered, was 55 per 1,000 births, as compared with 53 last year. The total number of deaths during the year was 95, as compared with 135, 114 and 90, the respective figures for the years 1925, 1926 and 1927. A further reference to the Infantile Mortality Rate will be found in the Section devoted to the Maternity and Child Welfare Scheme. For the whole of London the rate was 67, compared with 59 in 1927, 64 in 1926, and 67 in 1925, For England, and Wales the rate was 65, compared with 69 in 1927, 70 in 1926, and 75 in 1925. Locally the variations were from 35 per 1,000 births in Charlton, 40 in St. Nicholas, Deptford, 60 in East Greenwich, to 78 in West Greenwich. The following table shows at a glance these figures since the formation of the Borough:— District. Average for five years, 1901-1905, inclusive. Average for five years, 1906-1910, inclusive. Average for five years, 1911-1915, inclusive. Average for five years, 1916-1920, inclusive. Average for five years, 1921-1925, inclusive. 1926. 1927. 1928 East Greenwich 129 106 96 81 62 63 59 60 West Greenwich 126 110 112 110 80 66 49 78 St. Nicholas, Deptford 179 143 167 138 88 79 63 40 Charlton 121 109 76 89 66 48 45 35 Kidbrooke 39 79 16 39 13 — — — Borough 131 111 103 95 66 61 53 55 17 REMARKS ON VARIOUS DEATH CAUSES. Infective Diseases. Principal Epidemic Diseases.—There were 71 deaths due to this class of disease, equalling a Death Rate of .89 per 1,000; the rate last year was .54, and was 1.34, .58 and .54 in 1924, 1925 and 1926 respectively. Zymotic.—The purely Zymotic class of epidemic diseases is credited with causing a total of 61 deaths, equalling a Death Rate of .59 per 1,000. Locally the Zymotic Death Rate varied from .50 in Charlton (•04 in 1927), -60 in East Greenwich (.49 in 1927), .63 in West Greenwich (.40 in 1927), to. 94 in St. Nicholas, Deptford (.38 in 1927). Small-Pox.—There were no deaths from Small-Pox, this being the twenty-sixth year since a death occurred from this cause in the Borough. Measles.—There were 25 deaths ascribed as due to this disease (24 being under five years of age). This is equal to a Death Rate of .24 per 1,000. Thirteen occurred in East Greenwich, 7 in West Greenwich, 2 in St. Nicholas and 3 in Charlton. The number of deaths recorded last year was nil, and in the years 1924, 1925 and 1926, 28, 21 and 13 respectively. Scarlet Fever.—This disease occasioned one death, which occurred in East Greenwich. Three such deaths occurred in 1925, 1 in 1926 and 2 in 1927. Whooping Cough.—This disease was given as the cause of 8 deaths, with a death rate of .07 per 1,000. There were 16, 4 and 15 deaths respectively in the years 1927, 1926 and 1925. One death occurred in East Greenwich, 2 in West Greenwich, 2 in St. Nicholas and 3 in Charlton. Diphtheria.—There were 15 deaths during the year. This gives a death rate of .14 comparing with .10 for the previous year. Eleven deaths occurred in 1927. 12 in 1926 and 14 in 1925. Eleven of the patients were under five years of age. Typhoid Fever.—There were two deaths ascribed to this disease, both of which occurred in West Greenwich. There were 1 in 1924, 1925, 1926 and 1927 respectively. 18 Diarrhœa, Dysentery, and Zymotic Enteritis. — Ten deaths were said to be due to these causes, equalling a rate of .09 per 1,000. Last year there were 8 deaths, and 12 in 1925 and 1926 respectively. Influenza.—Influenza is found to have been the responsible cause of 8 deaths; 14 was the average for the previous three years. Three cases were over 65 years of age. Two occurred in East Greenwich, 4 in West Greenwich and 2 in Charlton. Tuberculosis. This class includes the causes of 121 deaths during the year under review, with a rate of 1·17; these figures compare with 117, 117 and 97, the totals of the years 1925, 1926 and 1927 respectively, and the respective rates of 1·12, 1·12 and ·97. Tuberculosis of the Lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 108 attributed to this cause, or a ratte of 1·08 per 1,000, as compared with ·78 last year. Locally the deaths were 41 in East Greenwich (death rate .90), 9 in St. Nicholas (death rate 121), 26 in Charlton (death rate 1.19), and 32 in West Greenwich (death rate 1.19). The remaining forms of Tuberculosis were responsible for 13 deaths, 6 of which occurred in East Greenwich, 4 in West Greenwich, 2 in Charlton and 1 in Kidbrooke. Cancer. This disease was responsible for a total of 147 deaths for the year, being a higher mortality than for some years past. The following Table is designed to show the seats of the disease at various ages in the different districts of the Borough:— 19 CANCER. Year 1928. MALE. Buccal Cavity Oesophagus Stomach Liver and Gall Bladder Intestines Rectum Prostate Glands Other Organs Total 25—45 yrs. 45—65 yrs. 65 & over. 25—45 yrs. 45—65 yrs. 65 & over. 25—45 yrs. 45—65 yrs. 65 & over. 25—45 yrs. 45—65 yrs. 65 & over. 25—45 yrs. 45—65 yrs. 65 & over. 25—45 yrs. 45—65 yrs. 65 & over. 25—45 yrs. 45—65 yrs. 65 & over. 25—45 yrs. 45—65 yrs. 65 & over. 25—45 yrs. 45—65 yrs. 65 & over. East Greenwich ... 1 3 ... ... ... ... 1 7 ... 2 1 ... ... ... ... 1 1 ... ... 1 ... 7 4 29 West Greenwich ... 2 2 ... 1 1 1 ... 2 1 1 1 ... 1 3 ... 2 ... ... ... 1 1 3 1 24 St. Nicholas ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 4 Charlton ... ... ... ... ... 1 ... 1 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... 4 1 11 Kidbrooke ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 Whole Borough ... 4 6 ... 1 2 1 2 10 1 3 3 ... 1 5 ... 3 2 ... ... 3 1 15 7 70 FEMALE. (Same age periods) Breast Genital Organs Other Organs East Greenwich ... ... ... ... ... ... ... 2 3 ... 5 1 ... 1 1 ... 1 1 ... 3 5 ... 2 1 ... ... 3 29 West Greenwich ... ... ... ... 1 ... 1 ... 2 ... ... 1 ... ... 3 ... ... ... 2 1 1 ... 1 2 ... 3 2 20 St, Nicholas ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... 1 1 1 ... 7 Charlton ... ... ... 1 ... ... ... 3 1 ... 1 1 ... ... 3 ... ... 2 ... 2 1 ... 2 ... ... ... ... 17 Kidbrooke ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... ... ... ... 4 Whole Borough ... ... ... 1 1 ... 1 6 6 ... 6 4 ... 2 7 ... 2 3 2 8 7 ... 8 4 ... 4 5 77 Total Deaths 147. 20 MORTUARY. The Council's Mortuary was erected in 1904, and is situate adjacent to the Coroner's Court in Lamb Lane. The number of bodies dealt with since 1916 is shown below:- Year Drowned Bodies from River Other Bodies Total 1916 11 182 193 1917 15 209 224 1918 24 138 162 1919 12 120 132 1920 14 175 189 1921 15 152 167 1922 14 166 180 1923 12 170 182 1924 21 182 203 1925 17 204 221 1926 23 214 237 1927 9 275 284 1928 10 351 361 21 SECTION 2. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Hospitals Provided or Subsidised by Local Authority. (1) Fever and (2) Small Pox.—Cases of Infectious Diseases are treated at the Hospitals of the Metropolitan Asylums Board. The only M.A.B. Hospital in the Borough, which is, situate at Shooter's Hill Road, near the Woolwich boundary, is the Brook Hospital. The nominal accommodation is 550 beds, including 104 in special Wards (Isolation, Separation, etc.). (3) Tuberculosis.—Sanatoria treatment for the area is provided by the London County Council. (4) Maternity.—Maternity Home, 78, Shooters Hill Road, Blackheath, S.E.3, provided by the Council. Accommodation comprises:— (1) Receiving Ward. (2) Two General Wards with 9 beds each. (3) Small Ward with 2 beds. (4) Isolation Ward with 1 bed. (5) Two Labour Wards. (6) Medical Officers' Room, Laundry, etc., together with residential accommodation for Matron. (Nurses, Probationers and Domestic Staffs accommodation is situate at 105, Shooter's Hill Road, which is opposite the Maternity Home). (5) Children.—No hospital is provided by Council, but arrangements are made with Deptford Fund for the treatment of Greenwich Children and Grant made by the Council for this purpose. A Grant is also made to the St. John's Hospital, Lewisham, in respect of minor operations performed on children referred to them by the Medical Officer in charge of the Infant Consultations. 22 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. No provision is made by the Council, but Dr. Barnardo's Homes National Incorporated Association have Finchley Lodge, St. John's Park, Blackheath, used for this and similar purposes. Ambulance Facilities. (a) Patients suffering from Infectious Diseases are conveyed to Hospital by the ambulances of the Metropolitan Asylums Board. (b) For Non-Infectious and Accident cases. No provision is made by the Council. Facilities afforded by the ambulances of the Metropolitan Asylums Board, London County Council and certain local Hospitals. The L.C.C. ambulances are available free of charge between the hours of 11 p.m. and 8 a.m. for all confinement cases entering the Council's Maternity Home, 78, Shooter's Hill Road, S.E.3. 23 Clinics and Treatment Centres. Name. Situation Nature of Accommodation By whom provided Period when held Maternity and Child Welfare Centres Borough Hall, Royal Hill, Greenwich 1 large waiting room 1 large weighing room 1 Consulting room Local Authority Thrice weekly Conduit House, Trafalgar Rd., E. Greenwich. Ditto Ditto Thrice weekly (a) Infant Consultations 105, Shooter's Hill Road, Blackheath. Ground floor consisting of large waiting room, large weighing room and Consulting room Ditto Twice weekly Armada Street Mission Hall, Deptford. Large Hall and consulting room Ditto Once weekly Charlton Vale Mission Hall, Woolwich Rd., Charlton. Large Hall consisting of waiting and weighing room and consulting room Ditto Once weekly (6) Pre- Maternity Borough Hall. (See above) Ditto Once weekly 105, Shooter's Hill Road, S.E. ( Do. ) Ditto Once weekly Conduit House, Trafalgar Rd., E. Greenwich. ( Do. ) Ditto Once weekly Charlton Vale Mission Hall, Woolwich Rd., Charlton. ( Do. ) Ditto Once weekly (c) Minor Ailments Borough Hall, 1 large room Ditto Daily (/) Artificial Sunlight Conduit House, Trafalgar Rd., E. Greenwich. 1 large room and dressing room Ditto Daily Nursery School Rachel McMillan Memorial School, 232, Church Street, Deptford, S.E. Extensive Miss Margaret McMillan Daily 24 Clinics and Treatment Centres—Continurd. Name Situation Nature of Accommodation By whom provided Period when held School Clinics Park Row, Greenwich. Whole House Local Medical Practitioners Daily Ditto Health Clinic, Deptford Green, S.E. Several Rooms Miss Margaret McMillan Daily Tuberculosis Dispensary, 7a, Maze Hill, Greenwich. Consulting Room and Dentist's Surgery. Separate Waiting and Cloak Rooms for Men and Women Pat ents, Nurse's Room and Dispenser's Room Local Authority Daily Venereal Diseases Miller General Hospital, Greenwich Rd. - — Daily Seamen's Hospital, Greenwich. — — Thrice weekly St. John's Hospital, Morden Hill, Lewisham. — — Twice weekly Tumour Diagnostic Consultation Dispensary, 7a, Maze Hill, Greenwich. Consulting and Waiting Rooms Local Authority Once weekly TUMOUR DIAGNOSTIC CLINIC. The Clinic was opened in October, 1927, and for the year ending 31st December, 1928, was attended ,by 31 patients (6 men and 25 women), who made 49 attendances. In addition, there were several inquiries from patients residing in other Boroughs. Of the 31 patients, 4 were sent by medical men, 5 came on the recommendation of other patients, the remainder attended as the result of propaganda in the form of leaflets, booklet's ("Better Health"), and from time to time articles in the local Press. Besides these, circular letters were sent out to all medical men in the Borough; to all the large works and factories; and again to all clergv with the request that the letters might be included in their Church Magazine. 25 The leaflets were distributed mainly through the Public Libraries, a copy being inserted in each book issued. "Better Health" is a booklet published monthly and distributed chiefly through the Welfare Centres and Tuberculosis Dispensary, containing, amongst other articles of Public Health interest, information as to the importance of seeking early medical advice re tumours, warts, cancer, etc., thus drawing attention to the Clinic. The leaflets and booklets have proved the most valuable aid in bringing patients to the Clinic., and there is evidence showing that this method of propaganda is inducing patients to seek early advice, not only at our own Clinic, but at the local Hospitals as well. The procedure adopted at the Clinic is as follows:—The preliminary examination is made by one of the Council's Medical Officers. If the condition complained of is definitely non-malignant the patient is so informed and referred to his own medical attendant. If, on the other hand, the condition is malignant or suspected to be so, then a consultation is arranged to take place at the private residence of the Council's Consultant (Mr. Davies Colley), and for this consultation a fee of two guineas is payable by the Council. During the year, nine cases were thus referred. The Consultant reports his diagnosis to the Medical Officer of Health, who in turn informs the general practitioner if the patient has been sent by such, or the patient himself should he have applied to the Clinic independently. In cases referred to the Consultant, if the condition complained of proves malignant, every endeavour is made to obtain admission to Hospital or to secure other appropriate treatment, whilst suspicious cases are kept under observation. So far this procedure has worked very satisfactorily, but it should be mentioned that if in the future the Clinic should become "popular," arrangements are in force for the personal attendance of the Consultant himself at the Clinic, thereby saving the patient a journey to town. Of the 31 patients who attended during 1928, seven gave a history of cancer in a member of the family, all on the female side. The conditions found might be classified as follows:— Recurrent Carcinoma, Breast 2 Uterine Fibroids 2 Mediastinal Growth 1 Haemorrhoids 2 Mastitis 5 Cirrhosis Liver 1 Ulcer of tongue (non-malignant) 3 Dyspepsia 5 Sebaceous Cysts 2 Lupus 1 Warts 3 Other Conditions 4 26 The one outstanding feature of the Clinic has been the lurking fear of "Cancer" seen in the eyes of many of the patients and the very evident relief experienced when they are informed that the condition is not malignant, would seem from this point of view alone, more than sufficient to justify the existence of the Clinic. The Clinic has been "approved" for another year. The problem before us is how to make its existence more widely known and how to keep the public interested in its objects. It is difficult to see how the methods of propaganda described above can be improved upon; at any rate for the present we are constrained to rely upon them as our chief aids. PUBLIC HEALTH STAFF. There was only one change in the personnel of the Department during the year. Dr. G. J. Sophian, who had been Maternity and Child Welfare Medical Officer since April, 1923, resigned in October, and was succeeded by Dr. Janet M. Morton. Professional Nursing in the Home. (a) General. No provision is made by the Council. (b) For Infectious Diseases. Arrangements are made with the Blackheath and Charlton District Nursing Association: St. John the Divine Home, Deptford. and the Ranyard Nurses for nursing selected cases of Measles, Ophthalmia Neonatorum, Influenza, Dysentery, Epidemic Diarrhœa, Malaria and Pneumonia, upon an intimation from the Public Health Department. The Council's Health Visitors also give advice and assist as far as possible. Midwives.—No district midwives are employed or subsidised by the Council. There are 30 practising in the district. Laboratorv Work.—The long-standing arrangement with the Bacteriological Department of the Seamen's Hospital has been in force throughout the year, whereby that Institution carried out all necessary pathological and bacteriological work for this Department, other than under the Sale of Food and Drugs Act, and in this connection 3,001 specimens have been examined for Diphtheria, 15 for Typhoid Fever, 376 for Tuberculosis, and 69 for other various conditions. Fuller details respecting results of the examinations of these specimens will be found under the different headings of the individual diseases. 27 Thirty tubes of Diphtheria Anti-toxin, containing a total of 240,000 units of serum, have been supplied during the year to Medical Practitioners for the treatment of patients suffering from this disease. HOSPITAL AND OTHER FORMS OF GRATUITOUS MEDICAL RELIEF. I am again indebted to the Secretaries of the Hospitals situated in the Borough for kindly giving me information regarding gratuitous medical relief. The Seamen's Hospital have admitted, treated and maintained 500 Greenwich patients for an average of twenty-six days each, as compared with 455 persons with an average of 15 days last year; in addition to which there have been 2,900 Outpatients, making approximately 8.700 attendances of persons belonging to the Borough of Greenwich. The number of Outpatients for the previous year was 3,240, which shows a decrease of 340, with a corresponding decrease in the number of Outpatient attendances. Miller General Hospital admitted, treated and maintained 300 Greenwich persons for an average of twenty-two days as against 421 last year. 8,910 Out-patients have also been treated, the total attendances being approximately 47,270. With the new ward block, which was formally opened by H.R.H. The Duchess of York on the 14th of May, 1929, the number of available beds was increased to 151. This additional accommodation consits of three wards, named "The Morris Ward," "The William Shepherd Ward," and the "Borough of Deptford War Memorial Children's Ward," each containing 24 beds and two private rooms for paying patients. The Children's Ward is specially constructed with glass partitions, so that in the event of an outbreak of infectious disease the area of infection may be limited. In the corridor of the new ward block the Borough of Greenwich War Memorial Tablet has been fixed. The other new extensions were the twin theatre suite consisling of two theatres, anaesthetic rooms, sterilizing room, duty room and surgeons' retiring room. The first part of the Nurses' Home, which was greatly needed, is situated in Catherine Grove. 28 Other improvements were the provision of adequate kitchen accommodation and stores. The number of special departments has been increased to 17, and are now as follows:—Medical, Surgical, Children's, Ophthalmic, Nose, Throat and Ear, Gynaecological, Electrical, Orthopaedic, Genito-Urinary, Pathological, Skin, X-Ray, Dental, Venereal, Massage, Swedish Remedial and Ultra-Violet Ray ("Artificial Sunlight"). The Convalescent Home at Bexhill-on-Sea has accommodation for 18 child patients, for whose exclusive need it is now used. The work in 1928 shows that even more use is being made by the people in South-East London. No. of In-patients 2,034 No. of Out-patients 29,677 (who made 189,070 attendances—including 64,955 attendances for Massage, Electrical and Ultra-Violet Ray treatment, and 21,348 attendances for Casualties). Blackheath and Charlton Cottage Hospital admitted 242 In-patients from Greenwich, the average duration of stay being 28 days; and also treated 879 Out-patients, who made 4,630 attendances for this purpose. POOR-LAW RELIEF. The Clerks of the Greenwich and Woolwich Boards of Guardians have been good enough to furnish me with the following figures for the year ended 31st December, 1928 :— Greenwich Parish St. Nicholas Deptford Charlton and Kidbrooke Parish Total number of families in receipt of out-door relief 3,566 715 565 Total amount expended in out-door relief £60,642 £14,241 £12,641 Total number of persons treated in Hospital 2,274 303 164 Total number of persons treated medically in their own homes 491 44 256 Total number of persons admitted to the Workhouse 491 62 28 29 LEGISLATION IN FORCE. List of Adoptive Acts, By-laws and Local Regulations Relating to the Public Health, in Force in the District, with Date of Adoption. By-Laws made under Public Health (London) Act, 1891, Sec. 16(1). — 4th Oct., 1902, and 18th Nov., 1904. By-Laws made under Public Health (London) Act, 1891, Sec. 16 (2). — 28th June, 1893, and 26th Nov., 1901. By-Laws made under Public Health (London) Act, 1891, Sec. 39 (1). — 28th June, 1893, and 3rd Jan., 1905. By-Laws made under Public Health (London) Act, 1891, Sec. 39 (2). — 4th October, 1902. By-Laws made under Public Health (London) Act, 1891., Sec. 45. — 11th July, 1905. Bv-Laws made under Public Health (London) Act, 1891, Sec. 50. — 4th October, 1902. By-Laws made under Metropolis Local Management Act, 1855, Sec. 202 (Plans). — 20th August, 1903. By-Laws made under Metropolis Local Management Act, 1855, Sec. 202 (Drainage).— 14th June, 1901, and 2nd January, 1924. By-Laws made under London County Council (General Powers) Act, 1903, Sec. 54. — 21st February, 1905. Provisions of London County Council (General Powers) Act, 1902, as to Ice Creams. By-Laws made by London County Council under Public Health (London) Act. 1891. and Sec. 6 of the Housing Act, 1925. By-Laws made under Public Health (London) Act, 1891. Sec. 19. — 25th Nov., 1907, 22nd March, 1922, 22nd Dec., 1923, 31st July, 1925. By-Laws made under London County Council (General Powers) Act, 1908, Sec. 9. — 18th Sept., 1923, 28th February, 1914, 20th June, 1928. By-Laws made under London County Council (General Powers) Act, 1902, Sec. 53. — 14th August, 1903. By-Laws made under Slaughterhouse, &c. (Metropolis) Act, 1874, and Local Government Act, 1888. — 27th October, 1891. Regulations as to Underground Conveniences — January, 1905. Metropolitan Borough of Greenwich (Measles and German Measles) Regulations. 1920. — 16th June, 1920. 30 SECTION 3. SANITARY CIRCUMSTANCES OF THE AREA. The tables on pages 31 to 33 and 37 to 43 summarise, as far as possible, the Sanitary work of the Department; from this it will be seen that a total of 24,223 houses and premises have been inspected or re-inspected during the year; 1,476 intimation notices and 110 statutory notices have been served. It is very gratifying to be able to report that it was not found necessary to institute Police Court proceedings in any instance during the year. There were altogether throughout the year 507 complaints registered. Factories, Workshops and Workplaces.—Three hundred and fifteen inspections have been paid to these premises within the Borough during the year. The number of factories, etc., on the register at the end of the year was 204 factories, 118 workshops and 37 wharves and quays. During the hot weather experienced in August last, complaints were received of a serious nuisance caused by a large firm in the district setting up a new process of drying and mixing stone for the manufacture of road-making material. On investigation it was found that the inhabitants in the vicinity suffered considerably from the dust and gritty particles which perculated into the houses, not only causing inconvenience but seriously affecting the health of the occupants. As the case was also one concerning the health of the employees, the matter was referred to H.M. Inspector of Factories for his co-operation. The business was closed temporarily until a dust-collecting apparatus was installed. No further complaint has been received by the Department and it is hoped that the measures taken will prevent any recunencc of the nuisance. Outworkers' Register.—Five lists, containing 24 names and addresses have been received from employers within the district. In addition to this, 42 lists containing 106 names and addresses of Outworkers residing in this Borough were received from Medical Officers of Health of other Boroughs, whilst 6 lists with 7 names and addresses were forwarded to other districts, thus giving a total of 123 Outworkers in the Borough. 110 visits of inspection have been paid to these premises. 31 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. 1.—INSPECTION. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 120 1 ... Workshops (including Workshop Laundries) 170 11 ... Workplaces (Other than Outworker's Premises) 25 1 ... Total 315 13 ... 2.—DEFECTS FOUND. Particulars Number of Defects N umber of Prosecut's Found Remedied Referred to H.M. Inspector *Nutsances under the Public Health Acts— Want of Cleanliness 14 14 ... ... Want of Ventilation 2 2 ... ... Overcrowding ... ... ... ... Want of Drainage of Floors ... ... ... ... Other Nuisances 4 3 2 ... Sanitary Accommodation— Insufficient 5 5 ... ... Unsuitable or Defective 3 3 ... ... Not Separate for Sexes ... ... ... ... Offences under the Factory and Workshops Act— Illegal Occupation of Underground Bakehouse (s. 101) ... ... ... ... Other Offences 28 28 ... ... Total 56 55 2 ... * Including those specified in Sections 2, 3. 7 and 8 of the Factory Act, as remediable under the Public Health Acts. 32 3.—Outwork in Unwholesome Premises (Section 108). Nature of Work Instances Notices Served Prosecutions Wearing Apparel (1) Making, etc. ... ... ... (2) Cleaning and Washing ... .... ... Lace, Lace Curtains and Nets ... ... ... Furniture and Upholstery ... ... ... Fur Pulling ... ... ... Umbrellas ... ... ... Paper Bags and Boxes ... ... ... Cotton and Kit Bags ... ... ... Brush Making ... ... ... Box Making ... ... ... Rackets and Tennis Balls ... ... ... Stuffed Toys ... ... ... Totals ... ... ... 4.—WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1928. No. Bakehouses 37 Factory Bakehouses 5 Barge Builders 11 Blacksmiths 5 Boot and Shoe Makers 10 Builders' Yards 4 Carpenters and Joiners 5 Carriage Builders 2 Coopers 2 Cycle Works 5 Dress and Mantle Makers 11 Engineers 3 Electrical Engineers 2 Fuel Works 2 Furniture 2 Laundries 1 Milliners 1 Monumental Masons 2 Motor Vehicle Repairers 10 Photographers 2 Picture Frame Makers 1 Plumbers 2 Tailors 13 Others 17 155 38 5.—OTHER MATTERS. Class. No. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Other 3 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (s. C):— Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspectors 2 Underground Bakehouses (sec. 101):— In use at end of 1928 13 Smoke Nuisances.—Fifty observations have been made for smoke nuisances during the year, but in no instance was it found necessary to serve a Statutory Notice. Although the provisions of the Public Health Act relating to smoke nuisances have been amended by the Smoke Abatement Act, 1926, so as to include smoke otherwise than black smoke, and the addition of soot, ash, grit and gritty particles, it is still very difficult for the Council to take official action against offenders. The London County Council, as the Central Authority, continue to inform us of certain nuisances of this class existing within the Borough, but for many years past we have been pressing the County Council themselves to abate the nuisance from their own premises, the Generating and Power Station, which undoubtedly is the worst delinquent in the district. Admittedly a considerable sum of money has been expended by them on efforts to completely eradicate nuisance from smoke, but up to the present without avail. Water Supply.—During the year 185 water supply certifi cates have been granted under Section 48 of the Public Health (London) Act. 1891. Eleven water supplies have been reinstated where the supply had been cut off ; water fittings have been amended in 92 cases; 8 water supplies have been altered so as to draw direct from the main, and covering cisterns in 163 cases. House Drainage.—One hundred and twenty-nine drainage systems have been reconstructed or repaired; 510 such systems have also been opened, cleansed and amended; 51 drains and soil pipes have been ventilated; 343 systems have been tested by smoke, 333 by water, of which number 133 were found to be defective; 39 new soil pipes and 200 traps (gully) hare been fixed, together with 12 intercepting chambers and fresh-air inlets, and 68 other chambers constructed. Forty-nine new covers to manholes have been provided; 52 systems have been sealed off or slurried up; 41 yards and 34 forecourts drained; 37 water-closets have been erected; 99 cleansed; 129 w.c. doors and seats repaired or provided; pan and traps have been furnished in 291 cases; and other fittings provided or improved in 175 cases, whilst the flushing apparatus has been amended in 444 instances. Public-house urinals have been cleansed and repaired in 8 instances. Customs and Inland Revenue Acts.—No applications were received during the year for certificates under these Acts. Horse Slaughterer.—The one horse slaughtering premises in the Borough has been inspected on four occasions and the cleansing of the premises duly carried out. Public Sanitary Conveniences. Speaking generally, the Borough is adequately served in the way of public sanitary accommodation. The conveniences are situated in the main arteries of traffic and there is no doubt whatever that the use by the public of such conveniences is on the increase. Appended is a Table showing particulars of the Public Conveniences and Urinals provided and/or maintained by the Council :— Particulars of Public sanitary Conveniences in the Borough. Convenience Men Women W.C.s Lavatory Basins Urinal Stalls Open Close W.C s Lavatory Basins Open Close a.m. p.m. a.m. p.m. Blackball Lane, East Greenwich South Street, 5 2 18 7.15 11.30 4 2 9.30 11.0 West Greenwich Creek Road, 4 1 10 6.45 11.0 4 2 9.0 10.30 St. Nicholas, Deptford 5 2 8 7.15 11.30 4 2 9.30 11.0 Batley Park, Blackheath 8 2 13 6.45 11.0 4 2 9.0 10.30 Blackheath Hill (foot of) 3 ... 10 6.45 11.0 4 ... 9.0 10.30 Totals 25 7 59 ... ... 20 8 ... ... Note—On Sundays, Conveniences open 10.30 a.m. and close 10.30 p.m. 35 Other urinals. Accommodation Woodman P. H 6 Antigallican P. H. 20 Angerstein P. H. 3 Park Row 6 King William Street 6 King William IV P. H. 2 Straightsmouth 9 Total 52 As a result of complaints as to the insufficient provision of lavatories for the use of visitors to Greenwich Park, and the lack of prominent notices as to the location of such conveniences, representations were made to His Majesty's Office of Works, who have informed the Council that it is proposed to extend the present Women's Convenience near the Bandstand, and further, to erect suitable indication notices. Houses Let in Lodgings.— The new Bye-laws made by the London County Council under Section 6 of the Housing Act, 1925, came into operation on the 5th March, 1926. At the end of 1927 there were one hundred and nineteen houses registered. Twenty-eight houses have been taken, off the register, such premises having been demolished under the L.C.C. (Watergate Street Area Scheme, leaving 91 on the Register at the end of the year; 122 inspections were made upon such premises. Rats and Mice (Destruction) Act, 1919.—Complaints as to rat infestation and cases coming to the notice of the Department are forthwith investigated. Advice and assistance are given where necessary. Three hundred and seventy-one such investigations were made by the Council's Officers, but in no case was it necessary to serve a Notice. The usual procedure was adopted in regard to "Rat Week," particulars of which have been dealt with in previous Reports. Verminous Premises.—As a means of assisting occupiers in the more densely populated parts of the Borough in ridding their premises of vermin, a supply of a special fluid is kept at the Borough Hall, and is supplied, together with the use of a sprayer, to occupiers whose premises have been reported upon by the Sanitary Inspector. Applicants are required tto bring their own bottles, and leaflets are distributed stating in simple language the method to be adopted. 36 During the year 180 gallons were given to approximately 1,350 applicants. There is no doubt the procedure outlined above has been of material help in dealing with this difficult problem. Increase of Rent and Mortgage Interest Restrictions Acts, 1920 and 1923.—Three applications were received during the year from tenants for certificates under these Acts. In each case the Certificate was granted. Scavenging and Refuse Disposal.—The collection of house, etc., refuse in the Borough is under the control of the Borough Surveyor, who has kindly supplied me with the following information relating to the disposal of refuse. The approximate amount of refuse collected in the Borough during the year ended 31st December, 1928, was 22,200 tons, giving an average daily collection of 77 tons. Of the total refuse collected, the Refuse Disposal Plant dealt with approximately 10,130 tons, giving a daily figure of about 40 tons. The remainder of the refuse was disposed of by barging and tipping. In order to cope with a larger quantity of refuse the Council have agreed to the provision of a second screen. A full description of the Screen and Disposal Plant was given in the Annual Report for 1925. 37 SUMMARY OF WORK PERFORMED BY THE SANITARY INSPECTORS DURING THE YEAR 1928. 1st Qtr. 2nd Qtr. 3rd Qtr. 4 th Qtr Total Inspections. Houses Inspected (House to House) ... 25 ... ... 25 ,, ,, Complaints, Nuisance 1337 551 687 538 3113 Other Premises Inspected 36 40 60 34 230 Re-inspections, Calls Made, etc. 6005 4740 2763 4230 17738 Inspections of Houses Let in Lodging 45 40 7 30 122 ,, Bakehouses 12 38 19 50 119 ,, Factories, Workshops and Workplaces 31 22 90 53 196 „ Outworkers' Premises 50 26 15 19 110 ,, Slaughterhouses 6 13 14 12 45 „ Cowhouses ... 3 4 ... 7 ,, Stables and Yards 10 11 26 13 60 „ Piggeries ... ... 1 ... 1 „ Courts and Alleys 5 2 1 1 9 ,, Fields, Lanes, etc. 10 7 7 6 30 ,, Urinals 15 14 28 25 82 „ Gipsy Vans 7 3 ... 1 11 ,, Horse Slaughterhouses ... 1 2 1 4 ,, Dairies, Cowsheds and Milkshops 8 67 60 9 144 „ Soap Boilers 1 1 1 1 4 ,, Other Offensive Trades 1 3 6 2 12 „ Ice Cream places 64 88 ... 152 „ Other places where food is prepared or stored 487 378 400 373 1638 Investigations (Rats and Mice) 98 88 60 125 371 Total 8224 6137 4339 5523 24223 Drains. Intercepting Chamber 1 6 3 2 12 Other Chambers Constructed 15 30 13 10 68 Reconstructions and Additions 25 62 20 22 129 Opened, Cleansed and Amended 96 136 205 93 510 Traps Fixed 39 69 37 55 200 New Soil Pipes 8 11 12 8 39 Soil and Vent Shafts Repaired 17 5 9 11 42 Drains and Soil Pipes Ventilated 5 21 8 17 51 Drains Sealed off, etc. 6 33 7 6 52 Drains tested—by Smoke 93 85 83 82 343 ,, by Water 102 133 50 48 333 Found Defective 39 62 7 25 133 New Covers to Manholes 11 19 9 10 49 Yards Drained 8 23 1 9 41 Washhouses Drained ... ... ... ... ... Areas Drained ... ... ... ... ... Cesspools abolished ... ... 1 ... 1 38 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Water Closets and Urinals. Closets erected 8 6 9 14 37 W.C. doors repaired or provided 39 19 19 52 129 Sanitary Conveniences or Improvements effected to Factories. Workshops and Workplaces 4 5 27 4 40 Flushing Apparatus Amended 78 121 159 86 444 Pans or Traps furnished 78 99 59 55 291 Cleansed 18 38 24 19 99 Ventilation improved 7 32 100 36 175 Public-house Urinals cleansed or repaired 3 ... 2 3 8 Other Urinals altered or cleansed ... ... 4 2 6 Other Urinals constructed ... 1 1 1 3 Ashpits. Provided 151 150 119 173 593 Covers to receptacles 1 … … … 1 Pavings. Forecourts and Yards 47 72 53 32 204 Washhouses 2 5 1 1 9 Mews and Stables 1 2 3 … 6 General Water Supply. Covers to Cisterns adapted 14 28 91 30 163 Water Fittings amended 18 25 26 23 92 Cisterns cleansed and repaired 1 2 1 … 4 Water Services altered so as to draw direct from main 4 2 2 … 8 Water Supplies reinstated where cut off through defective fittings 6 3 1 1 11 Water Supply Certificates granted (Section 48) 8 43 97 37 185 Other Improvements. Verminous Rooms cleansed 18 27 37 24 106 Ventilation improved 56 59 76 69 260 Staircases repaired, amended, lighted, and ventilated 41 56 23 15 135 Leaky House Roofs and Gutters repaired 161 112 139 132 544 39 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Other Improvements—contd. Walls and Ceilings of Premises cleansed and repaired 297 401 479 277 1454 Stoves and Fireplaces repaired 47 29 30 38 144 Washing Coppers repaired 27 19 20 23 89 Sinks provided 26 26 33 21 106 Floors repaired 118 46 55 52 271 Ice Cream places cleansed or improved … 6 33 36 75 Other places where food is stored and prepared 3 22 22 13 60 Provision for Storage of Food … … … … … Other Nuisances Abated. Illegal use of Underground Room discontinued … … 1 1 2 Overcrowdings abated … … … … … Sink, Lavatory and Bath Waste Pipes disconnected, trapped or amended 37 50 47 51 185 Stack Pipes amended 19 27 27 19 92 Nuisances from dampness abated 91 67 55 60 273 Animals Kept in Unfit Places discontinued or removed 6 3 3 … 12 Dung Receptacles provided 1 … 3 … 4 Bakehouse Nuisances abated 1 10 5 12 28 Houses abolished, unfit for habitation 1 23 20 … 44 Accumulations of Manure and other obnoxious matter removed 9 12 25 7 53 Inundations abated 498 … 1 … 499 Contents of Rooms cleansed 14 6 3 15 38 Rat Infestation abated 21 30 24 30 105 Smoke Nuisances. Observations 12 4 10 24 50 Statutory Notices served (Sections 23 and 24) … … … … … Food and Drugs. Samples taken 140 111 114 74 439 Found Adulterated, &c. 9 5 2 3 19 40 Summary of Sanitary Work—continued. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Unwholesome Food Seizures made … … … … Voluntarily surrendered 1 Ox Liver Pork (107 lbs.) Pork (156 lbs. ) Apples (5 tons) Tea (4,300 lbs ) Dog Fish (42 lbs.) Imported Mutton (3,167 stone 7 lbs.) Salt (8,000 lbs.) Plaice (6 stone) 1 case Oranges Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Notices, Etc. Intimations served under Public Health (London) Act, 1891 (Section 3) 570 339 244 323 1476 Notices served— Under Housing Acts … … … … … Rats and Mice (Destruction) Act, 1919 … … … … … re Verminous Rooms … … … … … Under P.H.(L.) Act and Metropolis Management Act (re combined drainage) 11 … … … 11 W.C.'s (Factories, Workshops and Workplaces) … … … 1 1 Yards … … … 1 1 Miscellaneous 1 … 1 … 2 Statutory Notices served under Section 4 24 22 17 23 86 Statutory Notices re Ashpit provision 3 4 … 2 9 Complaints received and attended to 126 127 139 115 507 Letters written relating to abatement of Nuisances 67 69 57 52 245 Summonses applied for and issued … … … … … Magisterial Orders obtained and enforced … … … … … Drainage Plans received and examined 34 45 27 28 134 41 Return Made to London County Council. Proceedings during 1928. Premises Number of Places Number of Inspections, 1928 Number of Notices, 1928 Number of Prosecutions, 1928 On Register at end of 1927 Added in 1928 Removed in 1928 On Register at end of 1928 Cowsheds 1 — — 1 7 — — Dairies and Milkshops 128 4 — 132 144 3 — Slaughterhouses 3 — — 3 45 — — Other Offensive Trade Premises 2 — — 2 8 — Ice Cream Premises 158 10 24 144 152 — — Registered Houses Let in Lodgings 119 — 28 91 122 — Restaurants and Eating Houses 53 5 2 56 75 1 — Total Number of Intimation Notices served for all purposes 1,476 „ „ „ Statutory „ „ „ 111 Overcrowding, 1928— Number of Dwelling-rooms overcrowded 2 Number remedied — Number of Prosecutions — Underground Rooms— Illegal occupations dealt with during year 2 Number of Rooms closed 2 Insanitary Houses— Number closed under the Public Health (London) Act, 1891 — Number of Closing Orders made 5 Number demolished in pursuance of Orders 40 Number demolished voluntarily 4 Number repaired or Nuisances remedied under Public Health Act 1,836 Housing of the Working Classes— (a) Erected during the year (Municipal) 87 (Private Enterprise) 98 (b) In course of erection 150 42 Number of Verminous Premises cleansed under Sec. 10 of the London County Council (General Powers) Act, 1922 106 Number of Cleansing Baths given under Cleansing of Persons Act 14 Number of Children cleansed 811 Number of Premises cleansed— (a) After Infectious Diseases 896 (b) For Vermin 21 Shelter provided under Sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year — Number of Tenement Houses provided with Additional Water Supply 3 Number of Prosecutions ditto — Inland Revenue Acts— Number of Houses for which applications were received during the year — Number of Tenements comprised therein — Number of Tenements for which certificates were granted — Number of Prosecutions under By-Laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping animals in such a manner as to be injurious to health — (d) As to paving yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. — (f) As to cesspools and privies, removal and disposal of refuse, etc. — 43 (g) For securing the cleanliness of tanks, cisterns, etc. — (k) With respect to water closets, earth closets, etc. — (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-Laws) Act, 1899) — Mortuaries— No. of Drowned Bodies 10 „ „ Other „ 351 „ ,, Infectious ,, — 364 ,, ,, Inquests 344 44 SECTION 4. HOUSING. During the year 76 houses have been completed under the Council's Housing Scheme at Charlton Park. The total number of houses completed and occupied under the Scheme is 700, excluding 50 flats situated in various parts of the Borough. In addition, the Council has 31 wooden hutments in Tunnel Avenue, East Greenwich. Having regard to the cost of the land at the Charlton Park site, it was not deemed desirable to build further houses of the type already built by the Council, and accordingly arrangements were made by the Council for the sale of a certain portion of the land for the erection by private enterprise of 81 houses of the villa type, a stipulation being that priority of right of purchase should be granted to Greenwich residents. The majority of these houses were completed and occupied by the end of the year. Unfortunately there is still a shortage of houses in the Borough, and instances of acute overcrowding continue to be brought to the notice of the Department. In the hope of alleviating the present housing conditions, the Council appointed a Deputation to wait upon the officials of the Ministry of Health. It was contended by the Deputation that the whole question of housing should be dealt with on a national and not a local basis. It was further pointed out that the question of the Unhealthy Areas which were officially represented as far back as 1919 was still in abeyance. HOUSING RETURN, 1928. Number of new houses erected during the year:— (a) Total 185 (b) With State assistance under the Housing Acts:— (i.) By the Local Authority 76 (ii.) By other persons 109 1.—Unfit Dwelling-houses. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,828 45 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 25 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,836 2.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 606 3.—Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were dered fit after service of formal notice:— (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close Nil (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied Intimations 1,476 Statutory 111 (2) Number of dwelling-houses in which defects were remedied after service of formal notice:— (a) By owners 1,230 (b) By Local Authorities in default of owners Nil 46 (c) Proceedings under sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of representations made with a view to the making of closing orders 5 (2) Number of dwelling-houses in respect of which closing orders were made 5 (3) Number of dwelling-houses in respect of which closing orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which demolition orders were made Nil (5) Number of dwelling-houses demolished in pursuance of demolition orders Nil 47 SECTION 5. Inspection and Supervision of Food. Milk Supply.—The majority of milk supplied to this Borough is obtained from farmers and large firms outside the district. There is, however, one farm in the Kidbrooke area where 100 cows are kept, and which is under constant supervision. Cowhouses.—The three cowhouses in the Borough have been visited on seven occasions, and the required cleansing duly enforced. Milk and Diries (Amendment) Act, 1922.—Milk and Dairies Order, 1926.—At the commencement of the year there were 128 purveyors of milk on the Register of Dairies and Milkshops. Twenty-five new applications have been received during the year and added to the Register, and twelve names have been taken off, thus leaving a total of 141 purveyors of milk now registered. The number of premises registered at the end of the year was 132, and 144 visits of inspections of such premises have been made; notices were served upon the occupiers in three cases where dairies required lime-washing or were otherwise in an insanitary condition. Milk (Special Designations) Order, 1923.—This Order was made by the Minister of Health under the powers conferred on him by Section 3 of the Milk and Dairies (Amendment) Act, 1922. Under the Order, the Council, as the local authority, may grant licenses to distributors, such licenses to be valid only for a period ending on the 31st December in the year in respect of which it is granted. During the year the following licenses were granted for the sale of graded milk:— Distribution of Certified Milk 6 ,, „ Grade A (Tuberculin Tested) 5 „ ,, Pasteurised 7 ,, „ Grade A 3 Supplementary Licenses 4 (Principal Licenses granted by the Lewisham Borough Council). 48 Cautionary letters were sent to six milk sellers connected with one particular firm drawing attention to the improper use of a description resembling an authorised designation. Such intimations had the desired effect and no further infringement on the above Order was observed. Milk.—Result of Analytical and Bacteriological Examinations.—77 samples of milk were taken during the year, of which only three were found to be adulterated or below the standard fixed by the Ministry of Agriculture and Fisheries. Of the 77 samples, 16 were taken from handcarts in the streets. The following table shows the average composition of milk examined by the Analyst during the year:— Period No. of Samples Examined Average Composition of all Samples, i.e. Genuine and Adulterated Average Composition of Genuine Samples Ministry of Agriculture Standard Per cent. of Milk Fat Per cent. of Solids not Fat Per cent. of Milk Fat Per cent. of Solids not Fat Per cent. of Milk Fat Per cent. of Solids not Fat 1st Quarter 20 3.53 8.65 3.57 8.62 3.00 8.5 2nd Quarter 24 3.41 8.70 3.52 8.70 3rd Quarter 26 3.68 8.71 3.68 8.71 4th Quarter 7 3.67 8.69 3.67 8.69 77 Average for the Year 3.57 8.69 3.61 8.68 The undermentioned samples of milk were submitted to the Council's Pathologist, Dr. Arthur Davies, for bacteriological examination and found to be free from the presence of tubercle bacillus:— 6 Ordinary Milk. 2 Sterilized Milk. 2 Pasteurised Milk. 3 Certified Milk. 3 Grade A (T.T.) Milk. 16 Milk and Dairies Order, 1926.—This Order was made by the Minister of Health under powers conferred by the Milk and Dairies (Consolidated) Act, 1915, and revokes the Dairies, 49 Cowsheds and Milkshops Orders of 1885, 1886 and 1889, so far as they relate to England and Wales, and all Regulations made thereunder by Local Authorities. The general object of the Order is to ensure Milk being produced and delivered to the consumer in a clean and pure state. It is the custom of the Department to issue a copy of the Order to all persons applying for registration of dairy premises in the Borough in order that they may be aware of the general provisions regarding the standard of cleanliness required. Meat.—During the year it was not found necessary to seize any animal or meat exposed for sale, or deposited in any place for the purpose of sale, or preparation for sale. The following were voluntarily surrendered and destroyed: 19 tons, 15cwt., 3 qrs., 14 lbs. of Mutton; 2cwt., 1 qr. 11lbs. of Pork. The Public Health (Meat) Regulations, 1924, which came into force on the 1st April, 1925, provide for the better regulation and supervision of slaughter-houses and protection of meat against contamination by dirt, etc. There are 109 premises where meat, bacon, etc., are either stored or exposed for sale. Slaughterhouses.—The number of slaughterhouses in use in the Borough are as follow:— In 1920 In January 1928 In December, 1928 Registered — — — Licensed 4 4 3 4 4 3 Forty-five inspections were made by the Inspectors during the year. From information received from the licensees the following is the number of beasts, etc., slaughtered during the year:— Beasts 239 Pigs 809 Sheep 1,497 Calves 29 50 Other Foods.—Places where food is prepared have been visited on 205 occasions, improvements being required in 20 instances as detailed below:— Class of Premises Number of Lists Number of Inspections Number of Instances where matters needed attention At end of 1927 Added 1928 Removed 1928 At end of 1928 Hotel Kitchens 6 — 1 5 5 — Eating Houses 53 5 2 56 75 9 Fried Fish Shops 31 — 1 30 30 6 Pork Butchers and Sausage Manufacturers 29 - 1 28 62 4 Mineral Water Manufacturers 1 — 1 1 Others 24 — 1 23 32 1 Totals 144 5 6 143 205 20 The 20 instances where matters needed attention included 12 cases where the premises generally, or kitchen and scullery particularly, needed cleansing and lime-washing, 4 where the sanitary arrangements were defective, and 4 where shop fittings such as chopping blocks and gutting benches were either dirty or defective. In addition to the periodical visits and inspections of food shops, etc., supervision is also exercised on Saturday evenings and Bank Holidays. There is still need for marked improvement amongst the smaller and poorer type of shops in the way of handling and serving foodstuffs to the general public. This applies particularly to foods of the cooked variety; generally no attempt is made to wrap the article in greaseproof paper or even plain paper, and when, as is often the case, old newspapers are utilised, the possibility of the food being contaminated is very evident, and 1 am strongly of opinion that legislation is needed to put a stop to this malpractice. 51 Street Tracers.—The Regulations made in accordance with the provisions of the London County Council (General Powers) Act, 1927, requiring the licensing by this Council of all persons who are engaged in street trading, continue to operate. This licence shows the place where the trader not only sells his goods, but also where they are stored, and in this way we are able to pay particular attention to the premises and the manner in which articles of food intended for sale from barrows and stalls in the streets are stored and prepared for sale. At the end of the year 61 licences had been issued, of which 34 refer to premises above-mentioned. Unsound Food.—No seizures of unsound food were made during the year, but a number of tradesmen voluntarily surrendered certain articles of food as unwholesome or unfit for the food of man, particulars of which are set out on page 40. Ice Cream Premises.—There were 158 premises known at the commencement of the year where the manufacture or sale of this commodity was carried on; 10 have been added during the year and 24 taken off, leaving a total of 144 premises. These premises were inspected on 152 occasions, improvement required by way of cleansing of the premises in 5 cases, insanitary conditions remedied in 3 instances. There was no instance where the ice cream was found to be improperly stored. Bakehouses.—One hundred and nineteen inspections have been made of the various bakehouses in the Borough, and 28 nuisances found therein have been abated. At the end of the year there were 5 Factory and 37 other Bakehouses on the Register, 13 of which are underground. Food and Drugs Acts.—Four hundred and thirty-nine samples have been purchased under the provisions of the Sale of Food and Drugs Acts and submitted to the Public Analyst for analysis, of which 420 were certified to be genuine and 19 adulterated, the adulterations thus being equivalent to 4.3 per cent. of the samples taken, as compared with 3.6 per cent. last year. Of the total number of samples purchased, 77 were milk, of which 3 were certified to be adulterated; 66 were butter, of which 2 were found to be adulterated; the remaining adulterated samples were 4 of vinegar, 5 of sausages, 2 of sago, and 1 each of dripping, jam and pearl barley. It was only considered necessary to take legal proceedings in respect of one of the 19 adulterated cases. 52 Sale of Food and Drugs Acts.—Number and Description of Samples purchased for Analysis under the above Acts during the Year 1928 Description of Samples Number of Samples Purchased Number Genuine Number Not Genuine Baking Powder 5 5 - Bloater Paste 1 1 - Brawn 7 7 - Bread 7 7 - Butter 66 64 2 Cake 8 8 — Cheese 11 11 — Chicken and Ham Paste 1 1 — Cocoa 4 4 — Coffee 3 3 — Coffee and Chicory 1 1 — Corned Beef 16 16 — Cornflour 3 3 — Cream 1 1 — Custard Powder 3 3 — Dripping 11 10 1 Fish Paste 3 3 — Flour 11 11 — ,, Self-raising 4 4 — Jam 11 10 1 Lard 10 10 — Margarine 3 3 — Marmalade 1 1 — Meat Paste 1 1 — Medicine 2 2 — Milk 77 74 3 Mustard 9 9 — Pearl Barley 8 7 1 Pepper 5 5 — ,, Compound 1 1 — Potted Meat 1 1 — Rice 42 42 — ,, Ground 2 2 — Sago 10 8 2 Salmon and Shrimp Paste 1 1 — Sausages 10 7 3 ,, Beef 4 3 1 ,, Breakfast 14 13 1 Sugar 3 3 — Tapioca 21 21 — Turkey and Tongue Paste 1 1 — Vinegar 36 32 4 439 420 19 53 SALE OF FOOD AND DRUGS ACTS. Administrative Action Taken Regarding Samples reported to be NOT GENUINE. No. of Sample Description of Sample Nature of Adulteration Result of Proceedings 148 Milk Addition of 2% of Water Warning Letter 235 Do. Abstraction ot 59% of Kat Costs 29/- 1 Butter Contained 0·09% of Boric Acid equal to 63 grains per pound Warning Letter 26 Do. Contained 0·02% of Boric Acid equal to 14 grains per pound No action taken 69 Breakfast Sausage Contained 0·04% of Sulphur Dioxide equal to 400 parts per million Case investigated by M.O.H. Vendor and Wholesaler warned. 171 Sausages Contained Boric Acid to the amount of one hundreth of 1% Warning Letter 363 Do. Contained Sulphur Dioxide to the extent of 0 003 per cent, equal to 30 parts per million. Warning Letter 396 Beef Sausages Contained 0 15% of Boric Acid Warning Letter 11 Vinegar Contained 0·0025% of Sulphur Dioxide equal to 25 parts per million Warning Letter 205 Do. Slightly deficient in Acetic Acid. Warning Letter 233 Pearl Barley Contained Sulphur Dioxide to the amount of 0·01% Warning Letter 257 Sago Consisted entirely of Tapioca Warning Letter 381 Do. Consisted entirely of Semolina Warning Letter 435 Dripping Contained 0 01% of Boric Acid. Warning Letter 106 Sausages Contained 300 parts per million of Sulphur Dioxide Warning Letter 110 Vinegar Deficiency in Acetic Acid amounting to 2% Warning Letter 114 Raspberry Jam Contained 70 parts per million of Sulphur Dioxide Warning Letter 120 Milk Abstraction of 4% of Fat. Warning Letter 138 Vinegar Contained 25 parts per million of Sulphur Dioxide Warning Letter 54 The Public Health (Preservatives, &c., in Food) Regulations.—These Regulations were made on the 4th August, 1925, and Amending Regulations on the 10th December, 1926, and 25th June, 1927. Only certain articles of food specified in the first schedule of the Regulations may contain preservatives, which must either be sulphur dioxide or benzoic acid in proportions not exceeding that stated in the 3rd column of such schedule. Part 2 of the Regulations specify the colouring matlters which must not be added to foods. Boric acid, which hitherto has been used greatly as a preservative, is now entirely prohibited. As from the 1st January, 1928, Butter came within the scope of these Regulations, and on the same date the Public Health (Milk and Cream) Regulations, 1912, and Order, 1917, were automatically revoked. Of the total samples submitted to the Analyst, 12 were found not to comply in all respects with the above Regulations. The details of the infringements are set out hereunder:— Sausages (4).—Two samples contained a trace of boric acid, and one a minute portion of sulphur dioxide. In each case the preservative was derived from one of the ingredients used in the making of the sausage. In the remaining case the proportion of sulphur dioxide used was in accordance with the Regulations, but was not labelled in accordance with the 2nd Schedule. The matter was investigated by the Medical Officer of Health and the Vendor cautioned. Butter (2).—Both samples contained a trace of boric acid. The amounts disclosed were less than would be added for preservative purposes. Up to the 1st January, 1928, it was generally permissible to allow an amount of boric acid not exceeding 0.5 per cent., and as the samples in question were taken early in January, it is possible that old stocks were mixed with butter. In this connection it was suggested in the Ministry of Health's Circular No. 852 that in such circumstances no official action should be taken. Dripping (1).—This sample contained a slight trace of boric acid, which was possibly derived from the meat. Breakfast Sausage (1).—This sample contained 0.04 per cent, of sulphur dioxide, equal to 400 parts per million. On investigation into this case it was ascertained that the Vendor held a warranty from his wholesaler. The matter was accordingly taken up with the wholesale firm. 55 Vinegar (2).—Both these samples contained a trace of sulphur dioxide. As it is an acknowledged fact that this article may contain a certain proportion of sulphur dioxide, derived from such sources as sulphured casks, malt, finings, etc., it cannot be concluded that sulphur dioxide was added to the samples in question. Possibly later on vinegar may be added to the 1st Schedule of the, Regulations. Pearl Barley (1).—This sample contained sulphur dioxide to the extent of 0-01 per cent. As this article only came within the scope of these Regulations on the 1st April, 1928, the same remarks relating to the working off of old stocks mentioned above in regard to Butter apply in this case. Raspberry ]am (1).—This sample contained 70 parts per million of sulphur dioxide, being 0.003 per cent, in excess of that allowed under the Regulations. The offence in this case is almost negligible. Although in some cases outlined above the presence of a preservative has been detected, it would be difficult to prove that the same has been added to such article of food. Strictly speaking, therefore, such samples are not adulterated but are included under such heading in accordance with the Ministry of Health's Memo. No. 36/Foods, which states that samples "below standard, or otherwise not complying with prescribed requirements" are to be recorded in addition to adulterated samples. Procedure under the Food and Drugs (Adulteration) Act, Etc.—The following are the principal legal provisions relating to the composition and description of food and drugs (apart from provisions as to poisons and other special drugs) in force on the 1st January, 1929: — (a) Statutory provisions, viz.:— The Food and Drugs (Adulteration) Act, 1928. Section 4 of the Milk and Dairies (Amendment) Act, 1922. (b) Orders and Regulations made under repealed Acts and continued in force by the Food and Drugs (Adulteration) Act, viz.:— Order as to Registration of Margarine Factories, etc., 1900. Order as to Registration of Butter Factories, etc., 1907. Regulation as to Competency of Analysts, 1900. Sale of Milk Regulations, 1901 and 1912. Sale of Butter Regulations, 1902. 56 (c) Regulations made under the Public Health (Regulations as to Food) Act, 1907, and effective for certain purposes of the Food and Drugs (Adulteration) Act, viz.:— Public Health (Condensed Milk) Regulations, 1923 and 1927. Public Health (Dried Milk) Regulations, 1923 and 1927. Public Health (Preservatives, &c., in Food) Regulations, 1925 to 1927. Most of the legal provisions cited above are administered by Food and Drugs Authorities, and it is convenient thait they should be treated for the purposes of administration and report as constituting a single group of laws for securing the purity of food. 57 SECTION 6. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Notifications under the Provisions of the Public Health (London) Act, 1891.—During the year 4,832 cases have been notified under the above Act. The following table shows the comparison since 1923:— No. Year. 2,087 1923 3,516 1924 3,555 1925 2,869 1926 2,098 1927 4,832 1928 Small-Pox.—No case of this disease occurred during the year. Contacts. — Ten intimations were received from Medical Officers of Health of the Port Sanitary Authorities respecting 48 persons who had been in contact with Small-Pox and Bubonic Plague whilst on board ship. In every instance they were kept under observation for the usual period. Details respecting vaccination in the Borough are given in the Supplemental Vaccination Reports on page 66. Diphtheria.— Four hundred and sixty-four cases of Diphtheria were notified during the year, as compared with 319, 434, 503 and 448 respectively in the years 1924, 1925, 1926 and 1927. The distribution of these cases was as follows:—212 in East Greenwich, 89 in West Greenwich, 52 in St. Nicholas. 102 in Charlton, and 9 in Kidbrooke. Of this number, 459 were removed to the Hospital for treatment, but 31 of these cases were reported by the Hospital Authorities as not suffering from the disease. There were 15 fatalities due to this disease, which gives a case mortality of 3-2 per cent. Three thousand and one specimens were forwarded by medical practitioners for bacteriological examination from cases suspected to be diphtheria. Of this number, 2,717 were reported to give negative or doubtful result, and 284 were positive in character, being dealt with accordingly. 58 The quarterly incidence of the disease for 1928 has been as follows: — 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total East Greenwich 65 64 40 43 213 West Greenwich 32 32 12 13 89 St. Nicholas 18 16 9 9 52 Charlton 24 31 25 22 102 Kidbrooke — 4 3 2 9 Total 139 147 89 89 464 Membranous Croup.—There were 4 cases of Membranous Croup notified during the year. One, however, was discharged from Hospital, the diagnosis not being confirmed. Erysipelas.—Seventy-three cases were notified during the year, 31 being in East Greenwich, 5 in West Greenwich, 14 in St. Nicholas, 12 in Charlton, and 1 in Kidbrooke. Twentyfive of these patients were removed to a Public Institution in the district. Scarlet Fever.—Three hundred and seventy-six cases were notified during the year, as compared with 304, 371 and 486 cases respectively in the years 1925, 1926 and 1927 ; 171 cases were in East Greenwich,, 86 in West Greenwich, 41 in St. Nicholas, 66 in Charlton, and 12 in Kidbrooke ; 371 of these cases were removed to Hospital for treatment, 22 of which were returned as not suffering from this disease. There was 1 death from this disease during the year, compared wiitih two the previous year. Of the 371 ca,ses treated in Hospital, the following were certified to be suffering on discharge from Hospital with chronic disease:—Rhinitis Otorrhoea 2, Rhinitis 1, and Otorrhoea 1. There were no cases which could be described as "Return Cases." Typhoid Fever.—There were 12 cases of Typhoid or Enteric Fever notified during the year, 5 being in East Greenwich, 6 in West Greenwich, and 1 in Kidbrooke. The ages of the patients were: 2 between five and fifteen years, 6 between fifteen and twenty-five years, 2 between twenty-five and fortyfive years, and 2 between forty-five and sixty-five years. Eleven of the cases were removed to Hospital for treatment; two however, were discharged as not suffering from the disease. In 59 the years 1924, 1925, 1926 and 1927 there were 10, 8, 7 and 8 cases respectively. The average number for the previous ten years is 11. No case was traceable to the consumption of shell fish; There was only one fatality from this disease. Fifteen specimens were forwarded by medical practitioners for bacteriological examination from cases suspected to be Typhoid Fever in character, 2 giving a positive result. Puerperal Fever—Five cases of this disease were notified during the year, 3 of which occurred in the East Greenwich district and 2 in Charlton. There were 5 cases in 1927, 9 in 1926, 9 in 1925, and 6 cases in 1924. Puerperal Pyrexia.—There were 4 cases of this disease notified during the year. One case occurred in East Greenwich, 1 in Charlton and 2 in Kidbrooke. Two of the cases were removed to Hospital for treatment. Measles.—This disease was made permanently notifiable by an Order of this Council, approved by the Ministry on the 1st July, 1920. Measles was particularly prevalent during the first half of the year. The outbreak commenced in December, 1927, and it reached its zenith in May, gradually diminishing towards the end of July. Early in January the Metropolitan Asylums Board found it necessary to put into operation the scheme whereby only selected cases of measles could be admitted to their Hospitals. In accordance with arrangements made with the London County Council, warning leaflets were sent to the Head Teachers of all Elementary Schools in the Borough, in order that they might distribute the same to parents and guardians of the children attending such schools. Two thousand, nine hundred and thiry-four cases were notified during the year, as compared with 234 during the previous year, and 1,299 for the year 1926. Two hundred and twenty-three such cases were removed to Hospital for treatment. The ages and incidence of fatality of the disease were as follow :— There were 85 cases under 1 year of age, with 2 deaths at this age period, giving a case mortality of 2.3 per cent. 60 Between the ages of one to five years there were 1,271 cases, with 22 deaths, giving a case mortality of 1.7 per cent., 1,525 cases between five years and fifteen years, and 53 cases between fifteen years and sixty-five years, with 1 death, giving a case mortality of 0.6 per cent. The case mortality for the whole Borough works out at 0.8 per cent., as compared with 1.0 per cent, for the year 1926. Table showing number of Measles Cases reported during tbe year 1928. Quarter ended 31st March, 1928. Under 1 1 to 5 5 to 15 15 to 25 25& over Total East Greenwich 6 89 167 8 2 272 West Greenwich 5 79 88 3 1 176 St. Nicholas, Deptford 4 51 28 — — 83 Charlton 4 30 37 1 2 74 Kidbrooke — 1 5 — — 6 Total 19 250 325 12 5 611 Sources of N otipcation:— By Medical Practitioners 463 ,, Parents 32 Males. Females „ Health Visitors 8 295 316 ,, L.C.C. Schools 108 611 Quarter ended 30th June, 1928. Under 1 1 to 5 5 to 15 15 to 25 25 & over Total East Greenwich 23 400 572 13 4 1012 West Greenwich 9 225 250 3 2 489 St. Nicholas, Deptford 5 85 34 1 — 125 Charlton 15 206 221 3 2 447 Kidbrooke — 2 5 1 — 8 Total 52 918 1082 21 8 2081 Sources of Notification :— By Medical Practitioners 1476 „ Parents 156 Males. Females. „ Health Visitors 44 1012 1069 ,, L.C.C. Schools 405 2081 61 Quarter ended 29th September, 1928. Under 1 1 to 5 5 to 15 15 to 25 25 & over Total East Greenwich 6 42 41 4 - 93 West Greenwich 2 8 14 1 — 25 St. Nicholas, Deptford — 8 1 — — 9 Charlton 2 31 38 1 — 72 Kidbrooke — 1 4 — — 5 Total 10 90 98 6 — 204 Sources of Notification :— By Medical Practitioners 140 * ,, Parents 24 Males. Females. „ Health Visitors 7 105 99 „ L.C.C. Schools 33 204 Quarter ended 29th December, 1928. Under 1 1 to 5 5 to 15 15 to 25 Total East Greenwich 1 6 11 1 19 West Greenwich 1 1 1 — 3 St. Nicholas, Deptford — — — — — Charlton 2 6 7 — 15 Kidbrooke — — 1 — 1 Total 4 13 20 1 38 Sources of N notification — By Medical Practitioners 31 ,, Parents 1 Males. Females. „ Health Visitor 1 15 23 „ L.C.C. Schools 5 38 Total Cases in Year 2934 Zymotic Enteritis or Epidf.m;c Diarrhcea. —One hundred and four cases of diarrhoea were notified throughout the whole of the Borough, 61 being under one year of age and 53 between one and five. Fifty-five of such notifications related to patients in East Greenwich, 8 in West Greenwich, 21 in St. Nicholas, and 20 in Charlton. There were 10 deaths ascribed to Diarrhoea and Enteritis. Whooping Cough.—This disease was made permanently notifiable as from 1st November, 1921. 62 Five hundred and six cases were notified (compared with 401 in 1927), 69 being under one year of age, 267 from one to five, 168 from five to fifteen, 1 from fifteen to twentv-five and 1 from twenty-five to forty-five, the districts concerned being East Greenwich 184; West Greenwich 127; St. Nicholas 41; Charlton 147; and Kidbrooke 7. Each of these cases was visited and leaflets and instructions left, together with verbal advice respecting the isolation and care of the patient. Forty-five cases were removed to Hospital for treatment, of which number 3 were returned as not suffering from Whooping Cough. Epidemic Cerebro-Spinal Meningitis, Cerebro-Spinal Fever, or Post-Basal Meningitis.—There were only 2 cases of this disease notified during the year, both occurring in the East Greenwich district. Acute Polio-Myelitis.—There was only 1 case notified during the year, as compared with 2 cases in 1927, 2 in 1926, and 1 in 1925. Ophthalmia Neonatorum.—During the year 18 cases of this disease have been notified, 8 being in East Greenwich, 3 in West Greenwich, 2 in St. Nicholas, 4 in Charlton, and 1 in Kidbrooke. Further particulars of this disease will be found on pages 89 and 90. Malaria.—There was only 1 case of Malaria notified during the year, as compared with 8 cases in 1927. Encephalitis Lethargica.—There were no cases of this disease notified during the year, as compared with 1 last year. Glanders.—No case of Glanders has occurred within the Borough. 63 Anthrax and Hydrophobia.—No notification of any case of these diseases in man has been received during the year. Tuberculosis.—During the year there were 197 cases of Tuberculosis notified in the Borough, as compared with 192 for the previous year. Of this number, 160 were pulmonary cases, ordinarily known as Consumption, and 37 non-pulmonary, being Tuberculosis affecting other portions of the body than the lungs. Of this number of cases, 57 pulmonary and 15 non-pulmonary occurred on East Greenwich, 43 pulmonary and 10 non-pulmonary in West Greenwich, 13 pulmonary and 3 non-pulmonary in St. Nicholas, 44 pulmonary and 9 non-pulmonary in Charlton, and 3 pulmonary in Kidbrooke. The various ages of the patients were as follow:—Pulmonary cases from one to five, 2 cases; five to fifteen, 11 cases; fifteen to twenty-five,. 49 cases; twentyfive to fortty-five, 57 cases; forty-five to sixty-five, 36 cases; and 5 cases over sixty-five; whilst the Non-pulmonary were:— Under 1 year, 1 case; one to five, 8 cases; five to fifteein, 15 cases; fifteen to twenty-five, 6 cases; twenty-five to fortyfive, 4 cases; forty-five to sixty-five, 2 cases; and 1 case over sixty-five. Three hundred and seventy-six specimens were forwarded by medical practitioners for bacteriological investigation from patients suspected to be consumptive; 294 were reported to be negative and 82 positive. Disinfection has been offered and carried out in 127 cases, including 148 rooms and 280 articles of bedding, etc.; disinfectant has also been supplied to patients to disinfect sputum, etc., and sputum pots where such are found necessary. DISINFECTION. The new Disinfecting and Cleansing premises were opened in June, 1924, and are situate at Tunnel Avenue, Blackwall Lane, East Greenwich. 64 Number of Articles and Rooms Disinfected in connection with the Undermentioned Diseases for the 52 weeks ended 29th December, 1928. The following returns show in detail the amount of work performed during the year by the Disinfecting Staff : — Diseases, &c. Rooms Premises Entered Beds Palliasses Mattresses Bolsters Pillows Blanket Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected Cancer 39 29 23 2 13 14 48 31 14 8 14 20 187 Encephalitis Lethargica 8 2 — — — — — — — — — — — Scarlet Fever 365 334 230 2 120 171 546 622 53 40 200 165 2,149 Diphtheria 486 395 257 — 100 169 555 583 32 24 153 58 1,931 Enteric Fever & Paratyphoid 15 10 4 — 5 4 21 18 2 4 3 2 63 Puerperal Fever and Pyrexia 6 5 2 1 6 6 14 6 1 3 2 4 45 Tuberculosis 148 127 37 — 31 32 103 37 6 7 18 9 280 Other Diseases 52 43 11 18 48 30 140 63 6 23 4 62 405 Measles 24 13 — — 3 1 3 — — — — — 7 From Verminous Premises 24 20 15 5 9 7 8 8 1 8 9 21 91 Scabies 1 1 1 — — — — 2 — — — 3 6 Influenza and Pneumonia 5 5 4 — 2 1 4 — 1 — — — 12 Cerebro-Spinal Meningitis 4 4 — — 2 — 4 6 — — — — 12 Total 1,177 988 584 28 339 435 1,446 1,376 116 117 403 344 5,188 65 Number of Articles Destroyed in connection with the Undermentioned Diseases during the 52 weeks ended 29th December, 1928. Diseases, &c. Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Pieces Total No. Articles Destroyed Scarlet Fever 3 - 1 - - - — — - - 4 Diphtheria — — 2 — — — — — — — 2 Tuberculosis 5 — 4 3 12 6 2 7 1 15 55 Other Diseases 13 5 5 3 16 8 2 — 1 27 80 For Verminous Premises 7 7 1 1 — — — — — 50 66 Pneumonia — — 1 — 1 1 3 — 1 — 7 Total 28 12 14 7 29 15 7 7 3 92 214 66 Supplemental Vaccination Returns for 1927. Return made on or before the 9th of February, 1929, by Mr. E. S. Elliott, Vaccination Officer of the several Districts of the Greenwich Union, respecting the vaccination of children whose births were registered in his District from 1st January to 31st December, 1927, inclusive :— Registration SubDistricts comprised in the Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1927. Number of these Births duly entered by 31st Jan., 1929. No. of Births which on 31st Jan.. 1929. remained unentered in the Vaccination Register on account of— No. of these births on 31st Jan., 1929, not accounted for Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year, 1928. No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1928. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Certificates of conscientious objection received. Dead, Unvaccinated. Postponement by Medical Certificate Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. South Deptford 544 276 3 — 188 18 7 13 12 27 North Deptford 600 272 2 — 199 28 9 3 18 69 East Deptford 719 253 1 — 191 34 19 2 37 182 East Greenwich 814 412 1 — 227 40 20 12 32 70 West Greenwich 317 157 1 - 92 13 5 4 14 31 Total 2,994 1,370 8 — 897 133 60 34 113 379 1,571 1,309 Dated February 4th, 1929. e. S. Elliott, vaccination Officer. Total number of Certificates for year 1928 sent to other Vaccination Officers, 159 (not included in figures above). CHARLTON AND KIDBROOKE No. of Births entered in "Birth List Sheets" as registered from 1st January to 31st December, 1927 619 Statutory Declarations of Consciertious Objection 181 Removed to places unknown, or which cannot be found; and cases not traced 12 Dead Unvaccinatcd 16 Postponed by Medical Certificate 6 Not accounted for 1 Successfully Vaccinated 362 Removed to Districts the Vaccination Officer of which has been duly apprised 40 Insusceptible of Vaccination 1 Had Small-Pox — G. E. Oughton. 67 HOUSES INSPECTED AND INQUIRIES MADE IN CONNECTION WITH INFECTIOUS DISEASE. Number of Houses Inspected and Inquiries made by Infectious Disease Inspector 1,121 Number of Re-visits 2,985 The Health Visitors also visited 3,979 cases, and re-visited when required. The following books belonging to the Libraries, etc., were destroyed in consequence of Infectious Disease:— Central Library (Woolwich Road) 105 Branch Library (West Greenwich) 26 Branch Library (Charlton) 48 School Libraries 8 Total 187 The 1-ton Ford lorry which is fitted with interchangeable bodies for the conveyance of articles both before and after disinfection, has been in constant use during the year, and has greatly facilitated the handling of infected and disinfected articles. CLEANSING STATION, BLACKWALL LANE. The new Cleansing Station which forms part of the Disinfecting premises was opened in June, 1924, and is situate at at Tunnel Avenue, Blackwall Lane, East Greenwich. The arrangements made with the London County Council for reserving the use of the Cleansing Station on Mondays and Thursdays for the cleansing of verminous school children continue in operation. 68 The following table shows the number of children cleansed during the year:— 1st Quarter 204 2nd „ 199 3rd „ 180 4th „ 228 Total 811 Fourteen adults suffering from verminous conditions were also given cleansing baths. In every case the infested clothing was disinfected. NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1928. Disease. Total Cases Notified.* Cases admitted'to Hospital Total Deaths.* Small Pox - - - Diphtheria 464 459 15 Scarlet Fever 376 371 1 Enteric (including paratyphoid) 12 11 2 Puerperal Fever 5 4 2 Puerperal Pyrexia 4 2 - Pneumonia, Acute, Primary or Influenzal 131 48 10 Erysipelas 73 25 - Acute Polio Myelitis 1 1 - Cerebro Spinal Fever 2 2 - Membranous Croup 4 4 - Malaria 1 - - Ophthalmia Neonatorum 18 3 - Encephalitis Lethargica — — 2 Notifiable Locally. Measles 2934 223 25 Whooping Cough 506 45 8 Diarrhoea 104 7 10 * For particulars as to Age Groups see Tables at end of Report. 69 REPORT OF THE TUBERCULOSIS OFFICER. To the Medical Officer of Health. Sir, During 1928 there has been no material change in the work of the Department, and the following Report calls for no special comment this year. The Notifications and Deaths were as follow:— Notifications. Deaths. Pulmonary NonPulmonary Total. Pulmonary Non- Pulmonary Total. 160 37 197 108 13 121 and the averages for the previous ten years: — 226 94 114 22 These figures give an Incidence Rate for all forms of the disease of 1.91 per 1,000 of the population 1.16 pulmonary and •41 non-pulmonary), with a Death Rate for all forms of 1.17 per 1,000 population (1.03 pulmonary and .12 non-pulmonary). In 7 instances (3 pulmonary and 4 non-pulmonary) the diagnosis of Tuberculosis was not confirmed after observation at Dispensary or Hospital, so that the above Incidence Rates should be read at a slightly lower figure. For the past four or five years I have remarked upon the decline of Tuberculosis in the Borough, and the decline this year although less marked is still maintained. The Death Notification Interval of 72 patients who died of Pulmonary Tuberculosis in 1928 is shown below:— Information from Death Returns 1 Died within One Month of Notification 2 Died within Three Months of Notification 4 Died within Six Months of Notification 2 Died with Over Six Months of Notification 63 Revised Diagnosis.—The 7 cases in which diagnosis was not confirmed comprised:—1 Bronchiectasis, 2 Bronchitis, all notified as suffering from Pulmonary Tuberculosis; and 3 cases of simple enlargement of the neck glands, and one case of hip disease (coxa vara), all notified as Non-pulmonary Tuberculosis. Deaths.—During the year 121 persons died from Tuberculosis (all forms), giving a Death Rate of 1.17 per 1,000 population; 108 were due to the pulmonary form, equal to a rate of 1.03 per 1,000, which is 28 higher than the figure recorded last year. 70 Notifications and deaths from Pulmonary Tuberculosis, with the Incidence and Death Rates for the previous five years, are recorded below:— Year. Notifications Incidence per 1,000 Deaths Death Rate per 1,000 1923 213 208 115 1.12 1924 214 2 04 104 1.00 1925 197 1 90 104 100 1926 177 1 70 93 .89 1927 192 1 92 100 .96 Deaths from Non-pulmonary Tuberculosis, of which there were 13 (equal to a rate of .12 per 1,000), included 6 Meningitis. 1 of Abdominal Tuberculosis, 4 Bones and Joints, 1 Genitourinary, and 1 Miliary Tuberculosis. The 33 (corrected) Notifications of Non-pulmonary Tuberculosis included: — 1 case of General or Miliary Tuberculosis. 12 cases of Tuberculosis of the Glands (Neck). 7 „ ,, ,, Joints and Bones. 4 ,, ,, ,, Abdomen. 5 ,, ,, ,, Brain (Meningitis). 4 „ „ „ Other. Artificial Sunlight Clinic (Tuberculosis Section). At the close of 1927 there were 56 patients under treatment; during the year 85 new cases were sent from the Dispensary, making a total of 141. Discharges numbered 107, leaving 34 under treatment at the close of the year. Of the new cases, 76 were under 15 years of age., and 9 over 16 years of age. These new cases were further classified as follows:— Tuberculous Adenitis 14 Tuberculous Abdomen 4 Pleurisy with Effusion 2 Pretubercular and Malnutrition 54 Asthma and Bronchitis 5 Various 6 71 As in previous years, only lack of accommodation prevents many more cases being sent. No adults were recommended. The number of treatments totalled 2,242, an average of 15:9 per patient, and the procedure adopted remains the same as last year. In view of the anticipated removal of the Clinic to Royal Hill, no alterations were made with regard to equipment or apparatus. Recently some criticism about the value of this form of treatment have appeared in the Press, but whatever doubt there may be about the value of Ultra Violet Ray from the scientific point of view, there is no doubt at all about its clinical value. Of course, it is always possible to say that the patients might have improved without this form of treatment, but the fact remains that previous to its introduction patients of similar class and suffering from similar conditions did not show the same improvement in the same time nor in the same degree as those exposed to artificial sunlight; and judging from our own experience we have every reason to continue the treatment with confidence, provided always that due care is exercised in the selection of cases. This care we have endeavoured to exercise and certainly so far we have no unsatisfactory results to tabulate. The most notable improvement has been in the pretubercular or border line children; not that there has been any marked increase in weight, etc., but simply that the children seem healthier and brighter, whilst their nutrition has improved, all points which the patients have voluntarily remarked upon. Incidentally, it is interesting to note that daring a severe epidemic of measles during the winter, only 7 out of 70 children of this "delicate" class contracted the disease, although the degree of absenteeism from measles in the schools in the district varied from 15 to 20 per cent. Two cases of pleurisy with effusion, in which the effusion persisted for a considerable time, gradually cleaned up following exposure to Ultra Violet Ray. The gland cases, mostly cervical, all did well, although the enlargement did not entirely disappear. No cases of Pulmonary Tuberculosis were treated. Occupation.—There are no industries in the Borough which have any special bearing upon the Incidence of Tuberculosis, and the occupations of notified cases in 1928 show no marked difference to those quoted in previous Reports. 72 Housing.—The Housing condition presents little improvement and much overcrowding exists, many examples continue to be brought to the notice of the Public Health Committee by the Care Committee. It follows that the sleeping arrangements continue to be a very serious difficulty in the problems of infection. Of 208 patients suffering from Pulmonary Tuberculosis : 115 were sharing a bed. 55 had a separate bed but not a separate room. 38 had a separate room and a separate bed. As a result of much persuasion and perseverance on the part of the Tuberculosis nurses and the Care Committee, 4 patients who were sharing a bed have now separate beds, and 1 patient who shared a bed with three others, has had his sleeping arrangements so altered as to have only one partner; not an ideal arrangement, but the best that could be done under the circumstances, and a great improvement on the original state as found by the nurses. Apart from overcrowding, many sanitary defects have been reported to and dealt with by the Public Health Department. The eight shelters are in constant use. Bedsteads and bedding have been lent or supplied by the Council and other agencies. (See Report of Care Committee). At the close of 1928 the estimated number of persons suffering from Tuberculosis and residing in the Borough was as follows:— Men. Women. Children. Total. Pulmonary Tuberculosis 256 222 166 644 Non-Pulmonary 34 41 188 263 giving a total of 907 as against 862 in the previous year. Dealing with the Dispensary itself, 716 new patiients were examined during the year. The sources from which these patients came were as follow:— Doctors 249 Hospitals 15 School Medical Service 28 Ministry of Pensions 1 Own Application 74 Nurses (Contacts) 349 Contacts.—Much of the nurses' time is spent endeavouring to secure the examination of every contact. This year, out of a total of 564 contacts, 374 were examined, or almost 67 per cent., of whom 33 were found to be tuberculous, and 11 doubtfully so, these latter being still under observation. 73 The work of the Dispensary is shown in the statistical tabic on page 80 and explains itself. Sanatorium Treatment.—During the year 136 patients were sent to sanatoria, 87 under the County Scheme, 48 through the Guardians, and 1 through other sources. The average duration of residence was three months, but the same difficulties remain in finding suitable employment for those discharged fit for work. Two patients entered more than once. In addition, 63 children are attending the Open-Air Schools at Shooters Hill and Brent Knoll, and are all doing remarkably well. The Open-Air School brings practically all the advantages of the Sanatorium to the immediate homes of the children without in any way breaking with the home life or interrupting their education. They are or should be the schools of the future. The children are all periodically examined at the Dispensary, in addition to the supervision of the School Medical Officer. X-Ray Examinations.—During the year, 279 patients were examined at the Greenwich and Deptford Hospital. Of these, 212 were adults, and 67 children. The parts examined were Chest 246, Other 28. Sputum Examinations.—Of 376 sputum specimens bacteriologically examined at the Seamen's Hospital, 82 proved positive. At the same time, 141 specimens were examined at the Dispensary for Albumen, 57 being positive. Tuberculosis Care Committee. The Public Health Committee acted as this Committee during the year, and Miss Johnston, the Honorary Secretary, supplies the following brief information—information which falls far short of the actual amount of work done and assistance rendered:— "The Societies mentioned last year continue to render financial and other assistance to patients recommended from the Dispensary, e.g.. 25 patients received gifts of clothing on proceeding to Sanatorium, 8 bed or bedding to relieve sleeping accommodation at home, 4 were given letters for convalescent treatment and several received extra nourishment. To find employment of a suitable nature for returned sanatorium patients is our great difficulty and at the present time an almost hopeless task. The Borough Council have again this year taken two patients on their temporary staff, whilst another patient has been placed on the permanent establishment after 12 months' probation. 74 A sum of £138 13s. 0d. was collected from patients and their relatives on behalf of the London County Council towards the cost of treatment. As mentioned in previous reports, the Greenwich Board of Guardians continue to give the most sympathetic consideration to patients referred to them from the Dispensary. Handicraft Class.—This class was inaugurated in October, 1928, and has continued to meet every Friday since that date. Before the class opened, much spade work had to be done to raise the necessary funds to erect a Hut and provide tools and material. Grants were obtained from the National Association for the Prevention of Tuberculosis, from the Red Cross Society, from the Local Branch of the National Association of Local Government Officers, and further gifts of money were received by private subscriptions and proceeds of concerts, etc. The teacher is provided by the London County Council, and the patients pay a fee of 2s. per head per term. The Hut was duly opened on the 16th November, 1928. There has been an average attendance of 17, and all the pupils have shown a keen interest in the work, which at present is confined to the making of stools and fancy leather goods. Although the teacher only attends on the Friday morning, members of the class are at liberty to attend at the Hut any day between 10 a.m. and 4 p.m. and work at their leisure. The main idea underlying the scheme is to give those patients who are unable to work at their ordinary avocation, and who would otherwise lead an idle existence, a chance to usefully occupy their time and keep them from "brooding" over their disablement. The patients are at liberty to sell any article they make, they themselves only being charged with the actual cost of the material. The difficulty which has now to be confronted is that of obtaining a market for the goods, and all particulars will be gladly forwarded to any who feel interested in this effort." The Report on Dental Treatment by G. Francis Ferris, Esq., L.D.S., is subjoined. I am, Sir, Your obedient servant, M. Macdonald, M.D., Ch.B., D.P.H. 75 TUBERCULOSIS. Age-Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F 0 — — 1 — — — — — 1 2 1 6 4 2 — 3 2 5 5 1 7 5 — — — — 10 6 1 3 3 — 1 2 1 15 12 14 — 2 9 11 1 — 20 14 16 1 3 6 8 — — 25 14 24 — 3 8 8 1 1 35 15 9 — 3 12 4 — 1 45 18 8 — 2 14 7 1 — 55 9 6 — — 6 6 — — 65 and upwards 7 1 1 — 5 1 — — Totals 102 81 19 25 62 46 8 5 Particulars relating to the above Table are dealt with in the Report of the Tuberculosis Officer on pages 69 to 74. 76 (a) PULMONARY TUBEHCULOSIS.— Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1928, arranged according to the years in which patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates Previous to 1926 1926 1927 1928 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B plus) Alive Discharged as cured Adults- M. 47 3 3 F. 80 Children M. 85 F. 62 Disease arrested Adults M. 8 4 4 1 1 1 F. 34 1 1 Children M. 7 F. 9 77 Alive Disease not arrested Adults M. 38 7 22 11 40 9 7 8 3 18 10 ! 8 9 5 22 13 10 21 5 36 F. 51 8 4 4 16 17 1 1 2 8 3 5 2 10 18 6 15 3 24 Children M. 25 15 5 8 F. 19 8 7 3 Condition not ascertained during the year 55 Lost Sight of or otherwise Removed from Dispensary Register 280 20 32 23 75 6 3 2 2 7 2 3 4 1 8 4 2 2 Dead Adults M. 90 15 77 183 275 1 8 8 16 5 4 3 12 1 1 2 4 7 F. 56 14 50 130 194 2 1 2 5 8 1 2 8 2 12 1 1 J Chil1 dren M. 16 F. 26 5 5 1 1 1 1 1 Totals 988 72 185 356 613 60 13 21 19 53 33 22 30 13 65 47 19 38 13 70 78 (b) NON-PULMONARY TUBERCULOSIS.-Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1928, arranged according to the years in which the Patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates Previous to 1926 1926 1927 1928 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Alive Discharged as cured Adults M. 8 2 10 F. 8 1 5 14 Children M. 3 6 4 199 212 F. 10 3 161 174 Disease arrested Adults M. 2 2 2 2 F. 1 1 1 3 Children M. 3 1 12 16 F. 4 2 1 6 13 79 Alive Disease not arrested Adults M. 7 1 8 1 1 2 1 3 1 2 3 F. 2 2 3 7 1 1 1 3 1 1 1 3 2 2 Children M. 7 19 26 3 5 8 2 2 4 5 1 2 3 11 F. 5 1 6 12 1 1 2 1 1 2 2 1 2 3 8 Transferred to Pulmonary 2 1 8 11 1 1 Condition not ascertained during the year Lost sight of or otherwise Removed from Dispensary Register 19 3 2 112 136 1 2 1 4 3 1 4 Dead Adults M. 8 2 2 12 1 1 1 3 1 1 2 F. 2 2 2 6 1 1 Children M. 3 2 5 1 11 F. 2 2 1 7 12 Totals 96 23 21 545 685 8 2 4 10 24 8 4 2 5 19 10 2 6 6 24 80 Return of work carried out in connection with the Maze Hill Tuberculosis Dispensary for the Year 1928. DIAGNOSIS. Pulmonary. Non-pulmonary. TOTAL. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 40 27 6 3 3 1 9 4 43 28 15 7 (b) Doubtfully tuberculous — — — — — — — 5 4 3 3 (c) Non-tuberculous — — — — — — — — 44 65 61 45 13.—Contacts examined during the year:— (a) Definitely tuberculous 9 15 2 - - 1 2 4 9 16 4 4 (4) Doubtfully tuberculous - — - - - - - - 3 3 2 3 (c) Non-tuberculous — — — — — — — — 40 94 98 98 C.—Cases written off the Dispensary Register as (a) Cured — (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — - - — — — — 105 172 167 148 D.—Number of persons on Dispensary Register on December 31st:— (a) Diagnosis completed 190 157 74 35 39 29 95 46 229 186 169 81 (b) Diagnosis not completed - - - - — — — - 5 11 11 11 81 1. Number of persons on Dispensary Register on January 1st 67 2. Number of patients transferred from other areas and of "lost sight of" cases returned 21 3. Number of patients transferred to other areas and cases 14 lost sight of' 29 4. Died during the year 72 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 7 6. Number of attendances at the Dispensary (including Contacts) 5,229 7. Number of attendances of non-pulmonary cases at Orthopaedic Out- stations for treatment or supervision. — 8. Number of attendances at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light" treatment (b) Other special forms of treatment 8 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 53 10. Number of consultations with medical practitioners:— {a) At Homes of Applicants 27 (b) Otherwise 265 11. Number of other visits by Tuberculosis Officer to Homes 192 12. Number of visits by Nurses or Health Visitors to Homes for sary purposes 3,242 13. Number of (a) Specimens of sputum, &c., examined 159 (b) X-ray examinations made 274 in connection with Dispensary work. 14. Number of Insured Persons on Dispensary Register on 31st December 264 15. Number of Insured Persons under Domiciliaiy Treatment on 31st Dec. 42 16. Number of reports received during the year in respect of Insured persons :—(a) Form G.P. 17 9 (b) Form G.P. 36 23 Tuberculosis Dental Clinic. During the year 1928 the number of attendances and patients referred for treatment remains roughly the same. More fillings have been completed than in previous years, and this is rather gratifying, as one experiences considerable difficulty in persuading patients to have their teeth filled instead of extracted, the popular idea being that there is far less pain with extractions than with fillings. While in some cases this may be so, extractions often mean the use of dentures, or failing these, loss of masticatory powers. These patients are generally more amenable to conservative treatment than those of the Maternity Clinic, but the aversion to fillings of the latter may be due to the naturally hyper-sensitiveness of the expectant mother. The following are the particulars of the treatment carried out:— Sessions 25 Number of Patients 86 Attendances 133 Dentures supplied 3 Fillings and scalings 18 No. of Sessions gas administered 13 No. of patients received local anaesthetic 80 82 SECTION 7. Maternity and Child Welfare The various activities under the Council's Maternity and Child Welfare Scheme have been conducted on similar lines as heretofore. Infant Welfare Consultations.—Consultations are held at two Centres on each afternoon from 2 to 5 p.m., as follows: — Borough Hall, Royal Hill Monday, Tuesday and Thursday Conduit House, 236, Trafalgar Road Monday, Wednesday and Friday 105, Shooters Hill Road Tuesday and Friday Armada Street, Deptford Thursday Charlton Vale Wesleyan School Room, Woolwich Road Wednesday The following table shows at a glance the work undertaken at the various Infant Consultation Centres during the year:— Borough Hall Conduit House 105. Shooter's Hill Rd. Armada Street Charlton Vale Total Attendances 9,382 11,723 5,937 2,689 5,557 35,288 New Cases 368 377 269 123 155 1,292 Medical Consultations 4,151 4,120 2,554 1,283 3,276 15,384 Nursing Mothers seen by Doctors 1,340 1,638 1,165 476 798 5,417 All babies are weighed and advice given to the mothers at every attendance. With the exception of Armada Street, the attendances at the Centres all continue to show an increase in numbers. Pre-Maternity Clinics.—These are held at 10 a.m., as follow: — Borough Hall, Royal Hill Tuesday. Conduit House, 236, Trafalgar Road Wednesday. 105, Shooters Hill Road Friday. Charlton Vale Mission Hall, Woolwich Road Wednesday. Armada Street Mission Hall, Deptford First and third Thursdays in each month. 83 The attendances for the year were as follow:- Borough Hall 641 Conduit House 693 Shooters Hill Road 796 Charlton Vale 155 Armada Street 97 2,382 This figure of 2,382 shows an increase of 427 over last year's total. The following tables show (a) the number of visits made by the Health Visitors during the year in connection with Births and cases of Infectious Diseases, and (b) number of Infant Consultations and Pre-Maternity Clinics attended. Health Visitors' Visits, &c., 1928. Table A. Visits Re-Visits Total Infants under 1 year 1,774 3,766 5,540 Children, 1—5 years 176 4,675 4,851 Measles 3,132 345 3,477 Whooping Cough 660 125 785 Pneumonia 31 32 63 Puerperal Fever 4 1 5 Puerperal Pyrexia 2 1 3 Diarrhœa 118 55 173 Ophthalmia Neonatorum 32 34 66 Table B 5,929 9,034 14,963 Dental Treatment 63 2 65 Milk Scheme 108 25 133 Pre-Maternity Cases 385 49 434 Infant Consultations attended — — 1,053 Pre-Maternity Clinics attended — — 231 Sessions attended at Town Hall re Flood 59 — 59 Enquiries re Flood 483 — 483 Miscellaneous 84 1 85 In addition to the above, 1,204 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. Infantile Mortality. — The number of deaths of children under one year of age totalled 95, which gives an infantile mortality rate for the year of 54 per thousand births. How this figure compares with that of previous years is discussed earlier in the report. During the year 1928, however, a special report in regard to every case of infantile mortality was prepared, particularly in reference to Welfare Centre attendances and a 84 number of interesting facts emerge from a consideration of these reports. It will be appreciated, of course, that in certain cases Welfare Centre non-attendance could not possibly have had any bearing upon the cause of death, and one therefore has deleted from a consideration of this factor all cases of deaths of infants under the age of one month, as well as deaths due to accidents., etc. This reduces the number to 58, and the following figures are submitted :— Mothers in regular attendance at Welfare Centre 13 „ irregular „ „ „ 20 Attended Centres with previous children 2 Never attended Welfare Centres at all 23 58 It is gratifying to be able to observe that more than halt of the mothers of these infants were in attendance either regularly or irregularly at the Welfare Centres, and it is not submitted that, had attendances been made by the mothers of the 23 infants who had not attended, the lives of the infants would have been saved. On the other hand, it is significant to notice the type of case where there is a preponderance of nonattendance at the Welfare Centres, e.g., out of 6 deaths from Enteritis, no mothers were in regular attendance and two only attended occasionally. In the Pneumonia group, where there were 13 deaths, 2 mothers only were in regular attendance, 7 attended irregularly, and the remaining 4 never attended at all. Convulsions accounted for 4 deaths ; in 2 cases the mothers had never attended, whilst of the deaths from Debility, etc., Nvhich numbered 12, four mothers only were in regular attendance. The most remarkable feature in connection with vital statistics is the drop in the infantile mortality rate during the past 30 years. In 1901, 150 infants under the age of one year, died to every thousand born. Ten years later the proportion had been reduced to 100 per thousand, since which date there has been a steady drop until the present very low figure of 54 per thousand births has been attained. From the foregoing remarks, however, it will be appreciated that we have by no means reached finality yet in regard to the prevention of infantile mortality, and I am convinced that with the increasing scope of the Council's Maternity and Child Welfare scheme, and, it is hoped, the increased and more widespread attendance on the part of the Greenwich mothers at the Welfare Centres, that in times to come, one will be able to continue to report the steadily decreasing infantile mortality rate. It is, of course, impossible 85 to save every young life, accidents, taking the word in its literal sense or in its general sense, are bound to happen, but I do feel that constant endeavour will result in still greater improvement. Several of the reports contained references to the inadequate housing accommodation of some of the families in which the infantile deaths occurred, e.g., an infant dying from Enteritis was one of a family of 7, all of whom had to sleep in one room, and one infant whose death was due to suffocation, belonged to a family of 6 who had to live and sleep in one room. A further case was that of a baby who died front Pneumonia, where adequate attention could not be given owing to bad housing conditions. A still further point to remember in connection with, the subject of infantile mortality, is that in some instances at least, the vitality of the infant is lessened owing to the poor nutritional condition of the mother in consequence of unemployment of the husband or other economic causes. Convalescent Home Treatment. — Such cases as are recommended by the Medical Officers in charge of the various Welfare Centres as being in need of conv alescent home treatment are in the first place dealt with by the Committee and then referred to the Invalid Children's Aid Association to make the necessary arrangements for such treatment. The I. C. A. A. collect from the parents such proportion of the cosit as the families' circumstances will allow and further help is obtained from voluntary societies, the balance being borne by the Council. A grant of £15 was received from the Greenwich Rotary Club towards the cost of certain selected cases. During the year 90 children have been sent away for convalescence for periods varying from three weeks to six months. Arrangements were also made for a month's convalescence for four mothers, together with their babies. Minor Ailments.—Quite trilling minor ailments are dealt with by the Health Visitor. Other cases requiring hospital attention are dealt with by arrangement with St. John's Hospital, Lewisham, to which Hospital the Council makes a contribution of £50 per annum for this service. Home Nursing.—Children found by the Health Visitors to be in need of special nursing at their homes, are dealt with by the various Nursing Associations in the Borough to whom the Council make appropriate payment for such services. 86 Artificial Sunlight Treatment Centre.—This Centre which was opened on the 24th September, 1925, at Conduit House, 236, Trafalgar Road, is in use every day from 10 to 12.30, and 1.30 to 5 p.m., for cases referred to the Centre by the Medical Officers attending the Infant Welfare Consultations. The treatment is given by a fully trained and specially certificated nurse, and is conducted on similar lines to that recorded in previous Reports. The total number of cases treated during the year was 463, as compared with 335 for the previous year ; the number of treatments given being 10,505. The following were the conditions treated:— Rickets, and the prevention of Rickets 182 Underweight 68 Debility and Malnutrition 35 Bronchial 31 Convalescent from Infectious Cases 29 Anaemia 18 Premature babies 7 Enlarged glands of neck 7 Insomnia 7 Rheumatism 4 Strabismus 4 Constipation 3 Enlarged Tonsils 3 Mongals 2 Marasmus babies 2 Chorea 1 Ante-natal Mothers 32 Nursing Mothers 28 463 In view of the somewhat disparaging remarks concerning the efficacy of Artificial Sunlight Treatment made in the daily Press recently, the following brief reports from the Medical Officers in charge of the various Infant Welfare Centres are interesting :— Dr. Mcintosh finds that in cases of Rickets generally, the most striking results are obtained. Bony deformities are rapidly cured, the improvement from week to week being so marked as to claim the parent's attention. Children sleep well at night and hence a more natural order of life is established. Marked benefit is also obtained in cases of Malnutrition and Anaemia, but improvement in cases of this kind is always 87 dependent very largely upon overcoming the cause of the Malnutrition, such as poor housing, unemployment, etc. A class of case that has always responded readily to treatment is where a persistent cough has followed Whooping Cough. Here, not only is the cough cleared up, but a gain in weight is speedily obtained. Dr. Low has not been able to refer many children to the Centre, because her cases reside in the St. Nicholas Ward, which is some distance away from the Centre. (It is hoped shortly to have another Centre near the Borough Hall, when this difficulty will be removed.) Marked improvement has been observed in cases of general malnutrition and anaemia. In one case in particular the child slepl better, appetite improved and she was much more contented and gained weight steadily. Children who have recurrent bronchitis with nasal catarrh, etc., probably due to mild rickets, show marked improvement, as also do those of one year or eighteen months old who are late in teething, irritable and restless at nights. Dr. Johnson has referred a large number of children to the Centre and, speaking generally, there has been a very favourable response to the treatment, characterised by an improvement in general health, colour, bone formation, muscular tone and an increased resistance to infection. The increase in height and weight is pronounced. The mental condition has improved and neurotic children who have had screaming fits have been cured. One particularly interesting case was that of a child nearly three years old who could not speak. Artificial Sunlight Treatment, coupled with other care, produced speedy improvement, and within a comparatively short space of time the child was able to speak quite normally. Dr. Ball referred to the Centre ten cases of Rickets, of which nine showed definite improvement after two months' treatment. Cases of anaemia, underweight, etc., improved rapidly, and also marked improvement was experienced where children were convalescing after Measles, etc. Dr. Sophian also reports as to the improved health of the children referred to the Centre by him after a course of treatment, particularly in cases of Malnutrition, and adds that what has particularly impressed him has been tlhe fact thalt Artificial Sunlight Treatment conduces to healthful sleep, which in itself, of course, greatly facilitates an improved condition of health. 88 Maternity Home.—The year 1928 witnessed the largest number of admissions to the Maternity Home since its opening in the early part of 1922, the figure for the year in question being 328. The number of admissions during the preceding years were as follow :— 1922 (part of) 121 1923 228 1924 220 1925 295 1926 256 1927 270 The total number of admissions to the end of 1928 was therefore 1,718. Of the 328 patients admitted, 323 were delivered by midwives, medical assistance being necessary in five cases only. There were six cases of twins, so that the number of babies born was 334. It is very gratifying to be able to report that there was an entire absence throughout the year of any cases which presented dangerous complications. The following continue their good work in the Borough: — Local Medical Practitioners' School Clinic. Health Centre, Deptford Green. Rachel McMillan Memorial Nursery School. Deptford Fund—Babies' Hospital. — The arrangement made with the Deptford Fund still operates whereby they receive in their Hospital such Greenwich cases as are recommended by the Medical Officer for treatment (debility and dietetic disorders). 89 NOTIFICATION OF BIRTHS ACTS, 1907. The following table gives the number and charactger of the intimations received respecting births in the Borough:- 1920 1921 1922 1923 1924 1925 1926 1927 1928 Total Number of Births notified in each year . 2,714 2,564 2,257 2,348 2,245 2,257 2,096 1,995 2,063 (a) Attended by M dwives 1,494 1,452 1,484 1,591 1,563 1,668 1,660 1,592 1,727 (b) Attended by Doctors 1,220 1,112 773 757 649 589 436 403 336 Numbers of Still Births notified in each year 78 52 53 50 32 32 49 82 71 Number of Births registered in each year 2,648 2,366 • 2,185 2,276 2,258 2,108 2,027 1,912 1,939 Puerperal Fever and Puerperal Pyrexia Regulations, 1926.—These Regulations came into force on the 1st October, 1926. Five cases of Puerperal Fever were notified during the year, 4 of whom were admitted to Hospital for treatment. Unfortunately, one proved fatal. Four cases of Puerperal Pyrexia were notified. Seven notifications were received from Medical Practitioners in charge of Institutions and Nursing Homes and 2 from Private Practitioners. Both the latter cases were subsequently admitted to Hospital. There was only one case in which the services of the Council's Obstetric Specialist was sought by private practitioners. Ophthalmia Neonatorum. — Eighteen cases of this disease were notified during the year, and in addition there were 8 slight inflamation of the eyes reported ; 3 cases were removed to Hospital for treatment. Both eyes were affected in 14 cases and one eye only in the remaining cases. 90 Cases. Vision Unimpaired Vision impaired Total Blindness Deaths Notified Treated At Home In Hospital 18 15 3 18 — — — Measles.—See pages 59 to 61. Milk, Virol, &c., Supplied to Nursing and Expectant Mothers and Young Children.—In accordance with Circular 185 of the Ministry of Health, where the income falls within the Council's scale, milk may be granted either free or at reduced cost to :— (a) Nursing Mothers; (b) Expectant Mothers in the last 3 months of pregnancy; (c) Children up to 3 years of age. In addition dinners may also be given to Nursing and Expectant Mothers who are in necessitous circumstances. The whole of the milk supplied at our Centres is Full Cream Dried Milk, and the same procedure has been adopted with regard to the distribution as in previous years. The total amount of such Milk sold or distributed free to Nursing and Expectant Mothers and Young Children during the year was 55,'635 lbs. (24 tons, 16 cwts., 2 qrs., 27 lbs.). The following tables show (a) the amount of milk, etc., given away and number of applicants receiving same, and (b) quantities sold each quarter. 91 (a) Milk, Virol, &c., Distributed Free Quarter ended Milk Virol Malt & Oil Cod Liver Oil 1bs. No. of Recipients lbs. No. of Recipients lbs. No. of Recipients lbs. No. of Recipients March, 1928 9,557 5,774 620 1,240 2,353 2,353 4 8 June, ,, 9.691 7,136 736½ 1,473 2,250 2,250 5 10 Sept., „ 9,179 7,048 490½ 981 2,048 2,521 8 16 Dec., 10,154 7,246 529½ 1,059 2,498 2,984 2 4 Totals 38,581 27,204 2,376½ 4,753 9,149 10,108 19 38 (b) Milk, Virol, &c., Sold at Full or Reduced Prices. Quarter ended Milk Virol Malt & Oil Cod Liver Oil Total Amount Received lbs. lbs. lbs. lbs. £ s. d. 4,199 446 369 35 345 7 4 June, „ 4,403 328 186 26 346 9 0 Sept , ,, 4,012 196½ 135 17 308 8 4½ Dec., ,, 4,470 247 256 23 313 19 8 Totals 17,084 1,217½ 946 101 £1,314 4 4½ 92 Maternity and Child Welfare Dental Clinic. In the Child Welfare Clinic much unnecessary work is caused by the ignorant or perhaps overworked mother who allows the use of a dummy. This objectionable practice continues, with the result that many children have a malformed jaw, in, which the young teeth have no possible chance to grow correctly, and where the permanent teeth are doomed long before eruption. In addition, there is the great risk to the general health, for filth and germs adhere to the soft, sticky surface of the comforter, where they find an admirable culture medium, and so., with these horrible artificial teats, disease gains admittance to the oral cavity. A step in the right direction would be the State abolition of the sale of dummies, but even so, the lazy or ignorant mother who will not train her child will resort to making sugardummies, or will even tie a raisin in a piece of rag. Here the value of Health Week can be appreciated, for at such exhibitions excellent models and diagrams amply demonstrate the malformation of jaw, teeth and face caused by this disgusting practice. The number of patients referred for dental treatment during the year 1928 is slightly in excess of previous vears. The following are the particulars of the treatment carried out :— Sessions 26 Number of patients 189 Attendances 511 Dentures supplied 43 Fillings, Scalings, etc. 56 Extractions (N°) 370 Extractions (Local Anasæslhetic) 225 X-Ray 6 Baby Week Celebrations.—It was not deemed desirable this year to hold a Health Week on commercial lines, as was the case last year. The Council kindly placed at the disposal of the Special Committee who have charge of Health Week arrangements the use of the Borough Hall, and, as in former years, the mothers and children attending the Welfare Centres — some 1,500 in all — were invited to tea and entertainment on June 26th, 27th and 28th. The entertainment consisted of various dancing displays, cinema films, the latter being kindly loaned to us by the Health and Cleanliness Council, and community singing. The latter item was very popular indeed and enthusiastically entered into by all present. 93 Nursing Homes Registration Act, 1927.—On and after 1st July, 1928, all persons in charge of Nursing Homes must be registered with the Local Supervising Authority. We continue to make inspections of Nursing Homes in this district, although the Act does not definitely give us powers of supervision, but it was found in practice that the authorities of the Nursing Homes appeared to appreciate the visits of the officials of the Local Sanitary Authority. Maternal Mortality.—Enquiries into maternal mortality and morbidity continue to be made in this Borough as they have been done for many years past, so that any conditions which on examination are found and thought to be conducive in any way to the unfortunate result of the case are dealt with. In this way it is hoped to be able to give such advice or take such action as will prevent a similar occurrence in the future. Up to the present no difficulty has been experienced in making the necessary enquiries, in fact, all those concerned have usually expressed their appreciation of the efforts made by this department in this connection. I have no doubt it is due to the results that have thus been obtained for years past without occasioning any friction whatever, that have now culminated in the Ministry of Health taking up the matter more definitely, and drawing up of what might be termed regulations for the conduct of such enquiries on a general scale throughout the country in future. As indicated above, these enquiries continue to be made in Greenwich on the same lines as in the past. although an expression of opinion was made at a meeting of the Maternity Committee to the effect that such enquiries ought not to be made unless they are definitely put on a legal basis and made compulsory throughout the whole of the United Kingdom. Here again, however, I have no doubt the Government are simply following out what appears to have become the usual English practice, that a trial is made of a certain scheme bv voluntary effort, and after such voluntary effort has continued for some time and proved the value of such scheme, then definite legislation is brought forward to make the scheme compulsory. It would seem as if the latter stage has now been reached with regard to the Maternal Mortality enquiries. 94 Index of Contents. Page. Adoptive Acts, By-laws and Local Regulations 1-2, 29 Age Mortality 15 Ambulance Facilities 22 Anthrax 63 Area of Borough 8 Articles and Rooms Disinfected 64 Articles Destroyed 65 Artificial Sunlight Treatment 23, 70, 71, 86, 87 Baby Week Celebrations 93 Bacteriological Examinations 26 Bakehouses 51 " Better Health" 25 Births 11 Blackheath and Charlton Cottage Hospital 28 Books Destroyed 67 Cancer 18, 19, 24-26 Clinics and Centres 23, 24, 82 Cerebro-Spinal Fever 62 Cleansing Children 67 Complaints 30 Consumption 5, 18 Contacts 57 Convalescent Treatment 85 Cowhouses 37, 47 Customs and Inland Revenue Acts 34 Dairies, Cowsheds and Milkshops 41,47 Deaths, Tables showing Causes of and Aat Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Deaths, with Age Mortality 13, 15 Deptford Fund Babies' Hospital 88 Density of Population 8 Dental Work 81, 92 Diarrhœa and Zymotic Enteritis 17, 61 Diphtheria 17, 57, 58 Diphtheria Anti-Toxin 27 Disinfection 63-65 Duties and Powers of the Public Health Committee 1, 2 Duties and Powers of the Maternity and Child Welfare Committee 3 Elevation of Borough 8 Encephalitis Lethargica 62 Enteritis 17, 61 Epidemic Cerebro-Spinal Meningitis 62 Epidemic Diseases 17 Erysipelas 58 Factories and Workshops 30 33 Fever Hospitals 21 Food and Drugs—Samples of 51-53 Food and Drugs (Adu lteration) Act 55, 56 Food—Premises for Preparation of, etc. 50 Glanders 62 Health Centres 23, 24 Health Visitors, Visits, etc. 83 95 INDEX—continued. Home Work 32 Horse Slaughterer Hospital and other forms of Gratuitous Medical Relief 27 House Drainage Houses Inspected re Infectious Diseases 67 Houses Let in Lodgings 35 Housing 44-46 Hydrophobia 63 Ice Cream Premises 41, 51 Increase of Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923 36 Infant Consultations 23, 82 Infantile Mortality 16, 83-85 Influenza 18 Inhabited Houses 8 Inland Revenue Acts 34, 42 Insanitary Areas 45 Institution Deaths Introductory Review 4-6 Laboratory Work 26 Legal Proceedings 30, 53 Marriages 10 Maternity and Child Welfare 82-93 Maternity Home 21, 88 Measles 17, 59-61 Meat 49 Midwives 26 Milk, Analysis of 48 Milk and Dairies (Amendment) Act, 1922 47 Milk and Dairies (Order), 1926 48-49 Milk Supply 47 Milk Supply for Expectant and Nursing Mothers 90, 91 Milk (Special Designations) Order, 1923 47 Miller General Hospital 27, 28 Minor Ailment Centre 85 Mortuary 20, 43 Notices, etc. 40 Notifications 57-63 Notification of Births Act 89 Nursing Arrangements 26 Offensive Trades 41 Ophthalmia Neonatorum 62, 89, 90 Outworkers' Register 30 Overcrowding 44 Persons Cleansed 42, 68 Polio-myelitis 62 Poor Law Relief 28 Population 8 Public Health Committee 1 Public Health (Meat) Regulations, 1924 49 Public Health (Preservatives, &c., in Food) Regulations 54-56 Public Sanitary Conveniences 34, 35 Puerperal Fever, &c. 59, 89 Rats and Mice (Destruction) Act, 1919 35 Remarks on Death Causes 17.19 River Thames Flood 6, 7 96 INDEX—continued. Sale of Food and Drugs Act 51-56 Sanitary Work—Summaries, etc. 37-40 Scarlet Fever 17, 38 Scavenging and Refuse Removal 36 School Clinic 24 Seamen's Hospital 27 Slaughterhouses 49 Small-pox 17 Smoke Nuisances 57 Staff of Public Health Department 26 Statistical Tables Appendix Street Traders 51 Tuberculosis 18, 63 Tuberculosis Dispensary—Returns 75 80 Tuberculosis Care Committee 73, 74 Tuberculosis Officer's Report 69-74 Tumour Diagnostic Clinic 24 26 Typhoid Fever 17, 58 Underground Bakehouses 33 Underground Rooms 41 Unwholesome Food 40 Uninhabited Houses 8 Vaccination Particulars 66 Verminous Premises 35 Verminous Children 67 Virol 91 Vital Statistics 8-10 and Appendix Water Supply 33 Whooping Cough 17, 61, 62 Workshops and Factories 31-33 Zymotic Enteritis 17, 61 Zymotic Diseases 17 BOROUGH OG GREENWWICH. Return of Births and Deaths registered during the 13 weeks ended 31st March, 1928. DISTRICTS Census Population, 1921. Estimated Population at the middle of the Year. Births Registered during the 13 weeks ended 31st March, 1928. Deaths Registered during the 13 weeks ended 31st March, 1928. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Tuberculosis, (Pulmonary). All other Forms of Tuberculosis. Bronchitis, Pneiimonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. Small-Pox. Measles Scarlet Fever. Diphtheria. Whooping Cough. Fevers All Causes. Seven Zymotics. Typhcid. Other. Diarrhœa and Dysentery. During the corresponding period year previous. During the 13 weeks ' ended 31st March, 1928. During the corresponding period year previous. During the 13 weeks ended 3lst March. 1928. Death Kate Birth Kate 1 M. F. M. F. Greenwich East 44213 44250 44445 91 100 75 64 16 11 61 ... 3 1 2 ... ... ... ... 7 1 15 30 11 69 13.85 12 .60 .44 .54 Do. West 26677 26828 26946 49 54 45 44 9 1 39 ... 1 ... ... ... 1 ... 1 9 ... 15 13 12 37 17.61 13.31 .73 .44 Sr. Nicholas, Deptford 7582 7419 7451 25 23 15 10 ... 3 6 ... 1 ... 1 ... ... ... ... 5 ... 3 5 3 7 16.83 13.52 .51 1.08 Charlton 18785 21653 21744 53 51 43 28 5 3 34 ... ... ... 1 ... ... ... ... 10 ... 7 13 8 32 16.15 13.16 .16 .18 Kidbrooke Miller Hospital— 3193 3300 3314 6 6 7 4 ... 2 4 ... ... ... ... ... ... ... ... ... 1 2 ... 1 7 12.07 13.37 ... ... Resident ... ... ... ... 3 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 3 ... ... ... ... Non-Resident Seamen's Hospital - ... ... ... ... 16 11 ... 1 6 ... ... ... ... ... ... ... ... 1 1 1 4 7 13 ... ... ... ... Resident ... ... ... ... 9 1 ... ... 1 ... ... ... ... ... 1 ... ... 2 ... ... ... 3 4 ... ... ... ... Non-Resident Greenwich & Deptford ... ... ... ... 13 1 ... ... 4 ... ... ... ... ... ... ... ... ... ... 1 ... 3 10 ... ... ... ... Hospital— Resident ... ... ... ... 44 36 6 5 30 ... 1 ... ... ... ... ... ... 4 ... 10 16 10 39 ... ... ... ... Non-Resident ... ... ... ... 80 70 12 10 42 ... 4 ... ... 4 ... ... 2 14 2 38 6 11 69 ... ... ... ... Herbert Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... M.A.li. Brook Hospital— Resident ... ... ... ... 1 1 ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 25 26 4 35 1 ... 37 ... 12 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Cottage HosriTAl.— ... ... ... ... 2 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 ... ... ... ... Non-Resident ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Other Institutions— Resident ... ... ... ... 3 7 3 1 4 ... ... ... ... ... ... ... ... ... ... 3 ... 1 6 ... ... ... ... Non-Resident ... ... ... ... 3 3 ... ... 4 ... ... ... ... ... ... ... ... ... ... 2 ... 1 3 ... ... ... ... Outside Institutions ... ... ... ... 41 26 7 10 25 ... 4 1 2 ... ... ... 1 9 1 9 4 3 33 ... ... ...• ... 224 234 185 150 Borough 100450 103450 103900 *458 335 30 20 144 ... 5 1 4 ... 1 ... 1 31 2 42 61 35 152 ... ... ... ... Rate per 1,000 ot Estimated Population ... ... ... 16. 69 12 .99 ... ... ... ... 19 .03 15 ... .03 ... .03 1 .20 .07 1.61 2.36 1.35 5.89 15.42 12.99 .45 .45 Gross Births Registered 497 Deaths of Children under 1 Year per 1,000 births, 65 (19'23 per 1000) previous 75 ,, „ „ corresponding 70 period ,, „ ,, County of London 80 Death Rate of 107 large English Towns, 14'2 of the County of London. 14 4 Birth Rate „ ff 17 3 ,, .. » 16 7. BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 30th June, 1928. districts Census Population, 1921. .Estimated Population at the middle of the Year. Births Registered during he 13 weeks ended 30th June, 1928. Deaths Registered during be 13 weeks ended 30th June, 1928 age mortality. Small-Pox. SEVEN ZYMOTIC DISEASES. Diarrhoea and Dysentery. Tuberculosis, (Pulmonary). All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000 Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. Measles Scarlet Fever. Diphtheria. Whooping Cough. Fevers All Causes. Seven Zymotics. Typhcid. Other. During the corresponding period year previous. During the 13 weeks ended 30th June, 1928. During the corresponding period year previous. During the 13 weeks ended 30th June, 1928. for Death Rate for Birth Rate M. F. M. F. Greenwich East 44213 44250 44445 84 119 72 57 13 13 54 ... 10 ... 5 ... ... ... ... 14 2 10 21 10 57 9.41 11. 70 .26 1.35 Do. West 26677 26828 26946 48 58 42 43 8 8 26 ... 4 ... 1 2 ... ... ... 8 2 12 10 10 36 10.54 12.70 .14 1.04 St. Nicholas, Deptford 7582 7419 7451 26 22 14 9 4 2 7 ... 1 ... 1 ... ... ... ... 3 ... 3 5 3 7 7.64 12. 43 ... 1.08 Charlton 18785 21653 21744 37 45 21 25 1 5 24 ... 3 ... 1 ... ... ... ... 4 ... 6 9 3 20 8.03 8.52 ... .74 Kidbrooke 3193 3300 3314 7 4 3 5 ... ... 4 ... ... ... ... ... ... ... ... ... ... 1 3 1 3 8. 44 9. 73 ... ... Miller Hospital— Resident ... ... ... ... 1 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... Non-Resident ... ... ... ... 18 3 9 ... 2 ... ... ... ... ... ... ... ... 2 ... 1 2 1 15 ... ... ... ... Seamen's Hospital— Resident ... ... ... ... 6 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 1 3 ... 2 ... ... ... ... Non-Resident ... ... ... ... 21 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 3 3 13 ... ... ... ... Greenwich & Deptford Hospital— Resident ... ... ... ... 85 26 ... 3 28 ... 1 ... ... ... ... ... ... 6 1 3 10 13 27 ... ... ... ... Non-Resident ... ... ... ... 70 53 8 5 44 ... 6 ... ... 3 ... ... .2 16 4 21 22 10 39 ... ... ... ... Herbert Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... M.A.B. Brook Hospital— Resident ... ... ... ... 6 5 6 4 ... ... 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 10 13 4 15 1 ... 12 ... 7 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Cottage Hospital— Resident ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Institutions— Resident ... ... ... ... ... 3 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... Non-Resident ... ... ... ... 2 3 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... Outside Institutions ... ... ... ... 32 28 5 8 17 ... 3 2 1 ... ... ... ... 6 1 6 8 5 28 ... ... ... ... 202 248 152 139 Borough 100450 103450 103900 450 291 26 28 115 ... 18 8 2 ... ... ... ... 29 4 32 48 27 123 ... ... ... ... Rate per 1,000 of Estimated Population ... ... ... 17.45 11. 28 ... ... ... ... .70 .30 .07 ... ... ... ... 1.12 .15 1.23 1.86 1.05 4.77 9.55 11.28 .15 1.09 Gross Births Registered 517 (19.96 per 1000) Deaths of Children under 1 Year per 1,000 births, 57 previous ) „ „ „ corresponding 60 period „ „ „ County of London 62 Death Rate of 107 large English Towns, H'5 of the County of London, 11.5 Birth Rate „ „ 17. 6 „ „ „ 16.4. BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 29th Sept. 1928. DISTRICTS Census Population, 1921. Estimated Population at the middle of the Year. Births Registered during the 18 weeks ended 29th Sept. 1928. Deaths Registered during the 18 weeks ended 29th Sept. 1928. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Tuberculosis, (Pulmonary). All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000. Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers Diarrhoea and Dysentery. All Causes. Seven Zymotics. Typhoid. Other. During the corresponding period year previous. During the 13 weeks ended 29th Sept. 1928. During the corresponding period year previous. During the 13 weeks ended 29th Sept. 1928. for Death Rate for Birth Rate M. F. M. F. Greenwich East 44213 44250 44445 76 89 35 58 3 1 37 ... ... ... 1 ... ... ... ... 8 3 9 11 18 43 8.44 9. 43 .44 .09 Do. West 26677 26828 26946 48 48 38 29 9 4 25 ... 2 ... ... ... 1 ... 2 4 1 3 8 10 36 743 10.03 .29 .74 St. Nicholas, Deptford 7582 7419 7451 18 17 6 7 1 3 5 ... ... ... ... ... ... ... ... ... ... 1 5 2 5 8.78 6. 73 .51 ... Charlton 18785 21653 21744 50 45 20 34 4 3 22 ... ... ... 1 1 ... ... 1 5 2 3 6 12 23 6.62 10.00 ... .55 Kidbrooke 3193 3300 3314 6 4 3 3 ... ... 4 ... ... ... ... ... ... ... ... ... ... ... 2 3 1 6. 11 7.29 ... ... Miller Hospital— Resident ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... Non-Resident ... ... ... ... 15 8 4 1 4 ... ... ... ... ... ... ... 3 ... ... 1 1 3 15 ... ... ... ... Seamen's Hospital— Resident ... ... ... ... 14 1 ... 1 2 ... ... ... ... ... ... ... ... 1 ... ... 2 4 7 ... ... ... ... Non-Resident ... ... ... ... 11 1 ... ... 2 ... ... ... ... ... ... ... ... 1 1 1 1 3 5 ... ... ... ... Greenwich & Deptford Hospital— Resident ... ... ... ... 30 35 3 2 29 ... ... ... ... ... ... ... 1 3 2 5 7 14 33 ... ... ... ... Non-Resident ... ... ... ... 44 35 6 5 32 ... 1 ... ... 1 ... ... 1 8 2 10 16 8 32 ... ... ... ... Herbert Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... M.A.B. Brook Hospital— Resident ... ... ... ... 2 ... 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 8 10 7 9 ... ... ... 4 5 6 1 ... ... ... ... ... ... ... 2 ... ... ... ... Cottage Hospital— Resident ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Institutions— Resident ... ... ... ... ... 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... Non-Resident ... ... ... ... 1 4 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 2 3 ... ... ... ... ... Outside Institutions ... ... ... ... 24 30 4 5 13 ... ... ... 1 1 ... ... 1 6 3 3 6 7 25 ... ... ... ... 198 202 102 131 17 11 94 Borough 100450 103450 103900 400 233 ... ... ... ... 2 ... 2 1 I ... 3 17 6 16 32 45 108 ... ... ... ... Rate per 1,000 of Estimated Population ... ... ... 15. 44 9. 01 ... ... ... ... .07 ... .07 .03 .03 ... .11 .66 .22 .63 1.26 1.54 4. 17 7.80 9.01 .30 .34 Gross Births Registered 465 Deaths of Children under 1 Year per 1,000 births, 42 (17. 94 per 1000) previous „ „ „ corresponding 43 period „ „ „ County of London 55 Death Rate of 10 7 large English Towns, 9'3 of the County of London, 9.1 Birth Rate „ „ 17. 0 „ „ 15.7. BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 29th Dec. 1928. DISTRICTS Census Population, 1921. Estimated Population at the middle of the Year. Dearths Registered during the 13 weeks ended 29th Dec., 1928. Deaths Registered during the 13 weeks ended 29th Dec., 1928. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Tuberculosis, (Pulmonary). All other Forms ot Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000 Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. Small-Pox. Measles Scarlet Fever. Diphtheria. Whooping Cough. Fevers Diarrhoea and Dysentery. All Causes. Seven Zymotics. Typhcid. Others. During the corresponding period year previous. During the 13 weeks ended 29th Dec., 1928. During the corresponding period year previous. During the 13 weeks i ended 29th Dec., 1928. for Death Rate for Birth Rate M. F. M. F. Greenwich East 44213 44250 44445 65 88 71 54 11 4 55 ... ... ... ... 1 ... ... 3 12 ... 11 24 18 56 10 .24 11. 33 .35 .36 Do. West 26677 26828 26946 51 50 44 39 6 3 33 ... ... ... ... ... ... ... 2 11 1 15 14 13 27 9. 80 12.30 .14 .29 St. Nicholas, Deptford 7582 7419 7451 21 22 14 10 2 4 7 ... ... ... 4 2 ... ... 1 1 ... 3 5 3 9 10. 84 12. 97 ... 1. 62 Charlton 18785 21653 21744 44 40 26 27 3 1 21 ... ... ... 1 2 ... ... ... 7 ... 9 14 5 15 10.51 9.81 ... .55 Kidbrooke 3193 3300 3314 8 4 3 1 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 2 1 1 9. 77 4. 86 1.22 ... Miller Hospital— Resident ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 ... ... ... ... Non-Resident ... ... ... ... 23 9 3 1 4 ... ... ... ... ... ... ... 1 ... ... 2 4 5 20 ... ... ... ... Seamen's Hospital— Resident ... ... ... ... 13 ... ... ... 1 ... ... ... ... ... ... ... ... 2 1 3 1 1 5 ... ... ... ... Non-Resident ... ... ... ... 19 2 ... ... 3 ... ... ... ... ... ... ... ... ... ... 1 1 5 14 ... ... ... ... Greenwich & Deptford Hospital— Resident ... ... ... ... 56 29 8 3 28 ... ... ... ... ... ... ... 5 16 ... 5 15 12 32 ... ... ... ... Non-Resident ... ... ... ... 69 41 9 5 39 ... ... ... ... ... ... ... 1 9 2 19 18 17 44 ... ... ... ... Herbert Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M.A.B. Brook Hospital— Resident ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 7 10 4 6 ... ... ... ... 7 3 1 ... ... ... 1 1 ... ... 1 ... ... ... ... Cottage Hospital— Resident ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Institutions— Resident ... ... ... ... 1 3 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... ... ... Non-Resident ... ... ... ... ... 6 1 ... 3 ... ... ... ... ... ... ... ... 1 ... ... 1 1 3 ... ... ... ... Outside Institutions ... ... ... ... 29 14 3 3 13 ... ... ... ... 1 ... ... 1 5 ... 7 7 6 16 ... ... ... ... 189 204 158 131 22 12 119 Borough 100450 103450 103900 393 289 ... ... ... ... ... ... 1 5 ... ... 6 31 1 38 59 40 108 ... ... ... ... Rate per 1,000 of Estimated Population ... ... ... 15.17 11. 24 ... ... ... ... ... ... .03 .19 ... ... .20 1.20 .03 1.40 2.32 1.55 4.17 10.19 11.24 .22 .46 Gross Births Registered 460 (17.70 per 1000) Deaths of Children under 1 Year per 1,000 births, 56 previous| „ „ „ corresponding 49 period „ „ „ County of London 69 Death Rate of 10.7 large English Towns, 11.6 of the County of London, 11.5 Birth Rate „ „ 161 „ „ 15.1 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 52 weeks ended 29th Dec. 1928. districts Census Population, 1921. Estimated Population at the middle of the Year. Births Registered during the 52 weeks ended 29th Dec., 1928. Deaths Registered during the 52 weeks ended 29th Dec., 1928. age mortality. SEVEN ZYMOTIC DISEASES. Tuberculosis, (Pulmonary). All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per l,000 Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. . Small-Pox. Measles Scarlet Fever. Diphtheria. Whooping Cough. Fevers Diarrhoea and Dysentery. All Causes. Seven Zymotics. Typhcid. Others. During the corresponding period year previous. During the 52 weeks ended 29th Dec., 1928. During the corresponding period year previous. During the 52 weeks ended 29th Dec., 1928. for Death Hate for Birth Rate m. F. m. F. Greenwich East 44213 44250 44445 316 395 253 233 43 29 207 ... 13 1 8 1 ... ... 3 41 6 45 86 57 225 10.59 11. 03 .49 .60 Do. West 26677 26828 2694C 196 210 169 155 32 16 123 ... 7 ... 1 2 2 ... 5 32 4 45 45 45 136 11.48 12. 10 .40 .63 St. Nicholas, Deptford 7582 7419 7451 90 84 49 36 7 12 25 ... 2 ... 2 2 ... ... 1 9 ... 10 20 11 28 11.11 11. 50 .38 .94 Charlton 18785 21653 21744 184 181 110 114 13 12 101 ... 3 ... 4 3 ... ... 1 26 2 25 42 28 90 10.66 10.37 .04 .50 Kidbrooke 3193 3300 3314 27 18 16 13 ... 2 15 ... ... ... ... ... ... ... ... 1 3 7 6 12 9. 16 8. 82 .30 ... Miller Hospital— Resident ... ... ... ... 7 8 1 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 11 ... ... ... ... Non-Resident ... ... ... ... 72 31 9 3 16 ... ... ... ... ... ... ... 4 3 1 5 11 16 63 ... ... ... ... Seamen's Hospital— Resident ... ... ... ... 42 2 ... 1 7 ... ... ... ... ... ... ... ... 5 1 4 6 8 18 ... ... ... ... Non-Resident ... ... ... ... 64 4 ... ... 9 ... ... ... ... ... ... ... ... 1 1 5 5 14 42 ... ... ... ... Greenwich & Depti-ord Hospital— Resident ... ... ... ... 165 126 14 12 115 ... 2 ... ... ... ... ... 6 29 3 23 4b 49 131 ... ... ... ... Non-Resident ... ... ... ... 263 199 35 25 157 ... 11 ... ... 8 ... ... 6 47 10 88 62 46 184 ... ... ... ... Herbert Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... M.A.B. Brook Hospital— . Resident ... ... ... ... 10 6 7 6 ... ... 6 ... 9 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... ... 50 59 19 68 2 ... 49 7 31 14 2 ... ... ... 1 2 ... ... 3 ... ... ... ... Cottage Hospital— Resident ... ... ... ... 2 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... Non-Resident ... ... ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... Other Institutions— ... ... 2 12 ... ... ... ... Resident ... ... ... ... 4 15 6 1 9 ... ... ... ... ... ... ... ... ... ... 3 2 6 10 ... ... ... ... Non-Resident ... ... ... ... 6 16 2 ... 11 ... ... ... ... ... ... ... ... 1 ... 2 3 6 10 ... ... ... ... Outside Institutions ... ... ... ... 126 98 19 26 68 ... 8 3 3 3 ... ... 3 26 5 25 25 21 102 ... ... ... ... 813 888 597 551 Borough 100450 103450 103900 1701 1148 95 71 471 ... 25 1 15 8 2 ... 10 108 13 128 200 147 491 ... ... ... ... Rate per 1,000 of Estimated Population ... ... ... 16.42 11.13 ... ... ... ... .24 .009 .14 .07 .01 ... .09 1.03 .12 1. 23 1.92 1.41 4.76 10.83 11.13 .36 .59 Gross Births Registered 1939 (18.72 per 1000) Deaths of Children under 1 Year per 1,000 births, 55 previous „ „ „ corresponding 53 period „ „ „ County of London 67 Death Rate of 10.7 large English Towns, 11.6 of the County of London, 11.6 Birth Rate „ „ 16 9 „ „ 15.9 BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 31st March, 1928. Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents " in Public Institutions in the District. All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke G'n'n'ch & Deptford Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital M.A.B. Cottage Hospital Other Institutions Outside Institutions Enteric Fever 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 ... 2 3 ... ... ... ... ... 3 1 1 ... ... 1 ... ... ... ... ... ... 4 42 Scarlet Fever 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Diphtheria and Croup 4 ... 1 2 1 ... ... ... ... 2 ... 1 1 ... ... ... ... ... 2 ... ... 2 14 Influenza 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System 31 ... 1 ... ... 11 4 14 1 7 9 5 10 ... 4 2 1 ... ... ... ... 9 22 Other Tuberculous Diseases 2 ... 2 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 3 Cancer, malignant disease 35 ... ... ... ... ... 1 16 18 11 12 3 8 1 10 3 ... ... ... ... 1 3 36 Rheumatic Fever 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 2 Diabetes 2 ... ... ... ... ... ... ... 2 1 ... ... 1 ... 1 ... ... ... ... ... ... 1 3 Cerebral Hæmorrhage, &c 17 ... ... ... ... ... ... 5 12 5 3 1 7 1 1 ... ... ... ... ... 1 2 4 Heart Disease 61 ... ... ... ... ... 3 17 41 30 13 5 13 ... 16 ... ... ... ... ... ... 4 27 Arterio-Sclerosis 20 ... ... ... ... ... ... 6 14 13 3 1 2 1 6 ... ... ... ... ... ... 1 17 Bronchitis 12 2 ... ... ... ... 1 2 7 4 4 2 2 ... 1 ... ... ... ... ... ... 1 13 Pneumonia (all other forms) 30 7 2 1 ... 1 1 10 8 11 11 1 5 2 9 ... ... ... ... 1 3 7 43 Other Respiratory Diseases 5 ... ... 1 ... ... 1 2 1 3 1 1 ... ... 3 ... ... ... ... 1 1 ... 9 Ulcer of Stomach or Duodenum 5 ... ... ... ... ... 1 3 1 1 1 ... 1 2 2 ... ... ... ... ... 1 2 4 Diarrhæa, &c. 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 2 Appendicitis 2 ... ... ... ... 2 ... ... ... 1 ... 1 ... ... 1 1 ... ... ... ... ... ... 3 Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ac. & Cr. Nephritis 17 ... ... ... 1 ... ... 7 9 7 7 ... 2 1 3 ... ... ... ... ... ... 7 11 Puerperal Sepsis 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... Other Accidents and Diseases of Pregnancy and Parturition 2 ... ... ... ... ... 2 ... ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... 2 Congenital Debility and Malformation, including Premature Birth 14 14 ... ... ... ... ... ... ... 7 5 ... 2 ... 1 ... ... ... ... ... 2 2 7 Violent Deaths, excluding Suicide 15 1 1 2 ... 3 1 3 4 5 4 ... 5 1 5 1 1 ... ... ... ... 5 21 Suicides 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Other Defined Diseases 49 5 1 1 4 1 3 9 25 24 12 1 11 1 13 2 2 ... ... 2 1 13 68 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 335 30 10 10 7 20 19 95 144 139 89 25 71 11 80 10 4 ... 2 4 10 67 361 Note.—All "Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 30th June, 1928. Causes of Death. Deaths at Subjoined ages of " Residents " whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of " Residents " in Public Institutions Total Deaths whether of "Residents" or "NonResidents" in Public Institutions in the District. All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 165 and upwards Greenwich East Greenwich West St. Nicholas, Deptford iCharlton Kidbrooke Gr'n'ch & Dept ford Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital M.A.B. Cottage Hospital Other Institutions Outside Institutions Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 18 2 7 8 1 ... ... ... ... 10 4 1 3 ... 1 ... ... ... 5 ... ... 3 24 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 2 1 ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 1 6 Diphtheria and Croup 8 3 2 1 1 ... ... 1 ... 5 1 1 1 ... ... ... ... ... 5 ... ... 2 12 Influenza 4 ... ... ... ... 1 ... 2 1 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System 29 ... ... 1 ... 12 8 7 1 14 8 3 4 ... 6 ... ... ... ... ... ... 6 24 Other Tuberculous Diseases 4 ... 1 1 ... 1 1 ... ... 2 2 ... ... ... 1 ... ... ... ... ... ... 1 5 Cancer, malignant disease 27 ... ... ... ... 1 ... 13 13 10 10 3 3 1 13 ... 2 ... ... 1 ... 5 31 Rheumatic Fever 2 ... ... ... 1 1 ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... 2 Diabetes 4 ... ... ... ... ... ... 2 2 3 ... ... 1 ... ... ... ... .... ... ... ... ... ... Cerebral Hæmorrhage, &c 14 ... ... ... ... ... ... 3 11 3 6 ... 4 1 3 ... ... ... ... ... ... ... 9 Heart Disease 48 ... 1 ... 1 2 4 14 26 21 10 5 9 3 10 3 ... ... ... ... ... 8 40 Arterio-Sclerosis 14 ... ... ... ... ... ... 2 12 9 3 1 1 ... 5 ... ... ... ... ... ... 1 19 Bronchitis 12 ... 1 ... ... 1 ... 1 9 4 4 ... 4 ... ... ... ... ... ... ... ... 2 7 Pneumonia (all other forms) 20 2 3 2 ... ... 5 2 6 6 8 3 2 1 3 1 ... ... ... ... ... 4 22 Other Respiratory Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ulcer of Stomach or Duodenum 2 ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 4 Diarrhoea, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Appendicitis 2 ... ... ... 1 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 2 2 Cirrhosis of Liver 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Ac. & Cr. Nephritis 10 ... ... ... ... 1 3 3 3 5 4 ... 1 ... 3 1 ... ... ... 1 ... 2 12 Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Other Accidents and Diseases of Pregnancy and Parturition 1 ... ... .... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... Congenital Debility and Malformation, including Premature Birth 9 9 ... ... ... ... ... ... ... 6 2 1 ... ... ... ... 1 ... ... ... 2 3 6 Violent Deaths, excluding Suicide 16 5 ... ... ... 4 ... ... 7 10 3 1 1 1 5 ... ... ... ... ... ... 7 10 Suicides 3 ... ... ... ... ... 2 ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 2 Other Defined Diseases 41 4 ... ... ... 1 3 10 23 19 12 3 7 ... 10 1 ... ... 1 ... 1 9 40 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 291 26 15 13 6 27 28 61 115 129 85 23 46 8 61 6 4 ... 11 2 3 60 281 Note.—All "Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it hare been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. Causes of, and Ages at. Death during the 13 weeks ended 29th Sept 1928. Causes of Death. Deaths at Subjoined ages of " Residents " whether occurring within or without the District Deaths at all Ages of " Residents " belonging to Localities, whether occurraing in or beyond the District Deaths of "Residents" in Public Institutions Deaths whether of "Residents" or "NonResidents" in Public Institutions in the District./ All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 ' 45 and under 65 *65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke Gr'n'ch & Dept. ford Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital M.A.B. Cottage Hospital Other Institutions Outside Institutions Enteric Fever 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 2 Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... 1 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Whooping Cough 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 7 Diphtheria and Croup 2 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 6 Influenza 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System 17 ... ... ... ... 5 7 3 2 8 4 5 3 1 ... ... ... ... ... 6 13 Other Tuberculous Diseases 6 ... ... 1 3 ... 1 1 ... 3 1 ... 2 ... 2 ... ... ... ... ... ... 3 5 Cancer, malignant disease 45 ... ... ... ... ... 2 23 20 18 10 2 12 3 14 4 ... ... ... ... ... 7 35 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 2 ... ... ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 Cerebral Hæmorrhage, &c. 15 ... ... ... ... ... 1 6 8 7 4 ... 4 ... 7 1 ... ... ... ... ... 1 10 Heart Disease 32 ... ... ... 1 ... 1 11 19 11 8 5 6 2 7 2 ... ... ... ... 2 6 31 Arterio-Sclerosis 2 ... ... ... ... ... ... ... 2 ... 1 ... 1 ... ... ... ... ... ... ... ... 1 2 Bronchitis 7 ... ... ... ... ... ... 1 6 4 ... ... 3 ... ... ... ... ... ... ... ... 2 5 Pneumonia (all other forms) 9 ... 1 1 1 1 ... 3 2 5 3 1 ... ... 5 ... ... ... ... ... ... 1 12 Other Respiratory Diseases 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 Ulcer of Stomach or Duodenum 3 ... ... ... ... ... ... 3 ... 2 1 ... ... ... 3 ... ... ... ... ... ... ... 5 Diarrhoea, &c. 3 3 ... ... 1 ... ... ... ... ... 2 ... 1 ... 1 ... ... ... ... ... ... 1 5 Appendicitis 2 ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... 1 ... ... ... ... 1 3 Cirrhosis of Liver 3 ... ... ... ... ... ... 1 2 1 2 ... ... ... ... 2 ... ... ... ... ... ... 3 Ac. & Cr. Nephritis 8 ... ... ... ... 3 ... 2 3 5 3 ... ... ... 4 ... ... ... ... ... ... 2 6 Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 2 Congenital Debility and Malformation, including Premature Birth 12 12 ... ... ... ... ... ... ... 2 7 1 2 ... 2 ... ... ... ... ... ... 2 6 Violent Deaths, excluding Suicide 9 ... 1 ... ... 1 3 ... 4 3 4 1 1 3 1 ... ... ... ... ... 3 13 Suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Defined Diseases 49 1 2 1 1 2 6 15 21 21 12 3 12 1 14 3 2 ... ... 1 13 47 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 233 17 7 4 6 12 23 71 93 93 67 13 54 6 65 15 3 ... 2 1 2 54 227 Note.—All "Transferable Deaths" of resident!, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 29th Dec., 1928. Causes of Death. Deaths at Subjoined ages of " Residents " whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of " Residents " in Public Institutions Total Deaths whether of "Residents" or "NonResidents " in Public Institutions [in the District. All Ages :Under 1 — 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke Gr'n'ch & Deptford Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital M.A.B. Cottage Hospital Other Institutions Outside Institutions Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Whooping Cough 5 2 3 ... ... ... ... ... ... 1 ... 2 2 ... ... ... ... ... ... ... ... 1 3 Diphtheria and Croup 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 8 Influenza 2 ... ... ... ... ... ... 1 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Encephalitis Lethargica 2 ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Tuberculosis of Respiratory System 31 ... ... 1 6 14 8 2 12 11 1 7 ... 16 2 ... ... ... ... ... 5 28 Other Tuberculous Diseases 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 4 Cancer, malignant disease 40 ... ... ... ... ... 3 13 24 18 13 3 5 1 12 1 ... ... ... ... 1 6 42 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Diabetes 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Cerebral Haemorrhage, &c 11 ... ... ... ... ... ... 4 7 6 4 1 ... ... 2 ... ... ... ... ... 1 ... 5 Heart Disease 59 ... ... ... 2 2 4 22 29 24 14 5 14 2 15 1 ... ... ... ... ... 7 40 Arterio-Sclerosis 16 ... ... ... ... ... ... 5 11 8 2 2 3 1 6 1 ... ... ... ... ... ... 18 Bronchitis 18 1 1 ... ... ... 1 3 12 4 8 2 4 ... ... 1 1 ... ... ... ... 1 8 Pneumonia (all other forms) 20 4 3 1 1 3 3 5 7 7 1 5 ... 5 2 ... ... ... ... ... 6 24 Other Respiratory Diseases 5 1 ... ... ... 1 ... 1 2 2 2 ... 1 ... ... ... ... ... ... ... 1 ... Ulcer of Stomach or Duodenum 2 ... ... ... ... ... 1 1 ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... 3 Diarrhoea, &c. 6 5 1 ... ... ... ... ... ... 3 1 2 1 ... ... 5 ... ... ... ... ... ... 1 7 Appendicitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Cirrhosis of Liver 2 ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 Ac. & Cr. Nephritis 5 ... ... ... ... ... ... 2 ... 5 ... ... ... ... 3 ... ... ... ... ... ... ... 6 Puerperal Sepsis 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 2 Other Accidents and Diseases of Pregnancy and Parturition 2 ... ... ... ... ... 2 ... ... 1 ... 1 ... ... 2 ... ... ... ... ... ... ... 3 Congenital Debility and Malformation, including Premature Birth 8 8 ... ... ... ... ... ... ... 4 3 1 ... 2 ... ... ... ... ... 1 ... 8 Violent Deaths, excluding Suicide 12 ... 1 ... 2 2 1 3 3 6 3 2 1 ... 6 1 ... ... ... ... ... 3 18 Suicides 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Othir Defined Diseases 38 1 1 1 2 6 7 20 20 9 3 6 ... 11 2 3 ... ... ... 1 10 52 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... 28S 22 10 2 7 14 37 78 119 125 83 24 53 4 85 13 4 ... 1 ... 4 43 293 Note.— All "Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded.. BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 52 weeks ended 29th Dec., 1928. Causes of Deaths. Deaths at Subjoined ages of " Residents " whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of " Residents " in Public Institutions Total Deaths whether of "Residents" or "NonResidents " in Public Institutions in the District. All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke Gr'n'ch & Dept ford Hospital Seamen's Hospital Miller Hospital j Herbert Military Hospital Brook Hospital M.A.B. Cottage Hospital Other Institutions Outside Institutions Enteric Fever 2 ... ... ... ... 1 1 ... ... ... 2 ... ... ... ... 2 ... ... ... ... ... ... 4 Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 25 2 11 11 1 ... ... ... ... 13 7 2 3 ... 2 ... ... ... 6 ... ... ... 68 Scarlet Fever 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 7 Whooping Cough 8 3 4 ... 1 ... ... ... ... 1 2 2 3 ... ... ... ... ... 8 ... ... 3 29 Diphtheria and Croup 15 4 3 4 3 ... ... 1 ... 8 1 2 4 ... ... ... ... ... 1 ... ... 5 40 Influenza 8 ... ... ... ... 1 ... 4 3 2 4 ... 2 ... ... ... ... ... ... ... ... ... 2 Encephalitis Lethargica 2 ... ... 1 ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 2 Men ngococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Tuberculosis of Respiratory System 108 ... 1 1 1 34 33 32 6 41 32 9 26 ... 29 5 1 ... ... ... ... 26 87 Other Tuberculous Diseases 13 ... 3 2 3 1 3 1 ... 6 4 ... 2 1 3 1 ... ... ... ... ... 5 17 Cancer, malignant disease 147 ... ... ... ... 1 6 65 75 57 45 11 28 6 49 8 2 ... ... 1 2 21 144 Rheumatic Fever 3 ... ... ... 1 2 ... ... ... 1 1 ... 1 ... 2 ... 1 ... ... ... ... ... 5 Diabetes 9 ... ... ... ... ... ... 3 6 5 1 ... 3 ... 1 ... ... ... ... ... ... 1 5 Cerebral Haemorrhage, &c 57 ... ... ... ... ... 1 18 38 21 17 2 15 2 13 1 ... ... ... ... 2 3 28 Heart Disease 200 ... 1 ... 4 4 12 64 115 86 45 20 42 7 48 6 ... ... ... ... 2 25 138 Arterio-Sclerosis 52 ... ... ... ... ... ... 13 39 30 9 4 7 2 17 1 ... ... ... ... ... 3 56 Bronchitis 49 3 2 ... ... 1 2 7 34 16 16 4 13 ... 1 1 1 ... ... ... ... ... 33 Pneumonia (all other forms) 79 13 9 5 1 3 9 18 21 29 29 6 12 3 22 3 ... ... ... 1 3 18 101 Other Respiratory Disease? 11 1 ... 1 ... 1 1 4 3 5 ... 1 1 ... 3 ... ... ... ... 1 1 2 10 Ulcer of Stomach or Duodenum 12 ... ... ... ... ... 4 7 1 4 5 ... 1 2 5 1 ... ... ... ... 1 4 16 Diarrhoea, &c. 10 9 1 ... ... ... ... ... ... 3 5 1 1 ... 6 ... ... ... ... ... ... 3 16 Appendicitis 6 ... ... ... 1 3 ... ... 2 1 ... 1 4 ... 1 1 1 ... ... ... ... 3 10 Cirrhosis of Liver 6 ... ... ... ... ... ... 3 3 2 2 ... 1 ... ... 2 ... ... ... ... ... 1 4 Ac. & Cr. Nephritis 40 ... ... ... 1 4 3 14 18 22 14 ... 3 1 13 1 ... ... ... 1 ... 11 35 Puerperal Sepsis 2 ... ... ... ... ... 2 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 2 4 Other Accidents and Diseases of Pregnancy and Parturition 6 ... ...... ... 1 5 ... ... 1 1 3 1 ... 3 ... ... ... ... ... ... 2 7 Congenital Debility and Malformation, including Premature Birth 43 43 ... ... ... ... ... ... ... 19 17 2 5 ... 5 ... 1 ... ... ... 5 7 27 Violent Deaths, excluding Suicide 52 6 3 2 2 10 5 6 18 34 14 4 8 2 J9 3 1 ... ... ... ... 18 62 Suicides 5 ... ... ... ... ... 2 3 ... 2 1 1 ... 1 1 ... ... ... ... ... ... 1 4 Other Defined Diseases 177 11 4 2 6 6 18 41 89 84 45 10 36 2 48 8 7 ... 1 3 3 45 207 Diseases ill-delined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114f 95 42 29 26 73 107 305 471 1 486 324 85 224 29 291 44 15 ... 16 7 19 224 1162 Note.—All ''Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. Cases of Infections Disease notified during the 13 weeks ending 31st March, 1928. Notifiable Disease Cases Notified in Whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each locality. At all Ages. At Ages—Years. Greenwich East Greenwich West St. Nicholas, Deptford. Charlton. Kidbrooke. (A) Greenwich East Greenwich West St. Nicholas, Deptford. Charlton. Kidbrooke. (H) Total. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... Diphtheria 139 4 41 78 9 7 ... ... 65 82 18 24 ... 65 32 18 24 ... 139 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 23 ... ... 1 3 8 7 4 7 1 7 7 1 3 ... 2 ... 1 7 Scarlet Fever 105 1 22 66 12 4 ... ... 43 22 12 27 1 40 22 12 27 1 102 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 4 ... ... 1 2 ... 1 ... 1 2 ... ... I 1 1 ... ... 1 3 Puerperal Pyrexia 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Puerperal Fever 4 ... ... ... 1 3 ... ... ... 3 ... 1 ... ... 3 ... 1 ... 4 Cerebro-Spinal Fever 2 ... ... 2 ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... 2 Membranous Croup 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 Measles 611 19 250 325 12 5 ... ... 272 176 83 74 6 21 19 16 4 1 61 Whooping Cough 34 6 18 10 ... ... ... ... 17 10 2 5 ... ... 1 ... ... ... 1 Diarrhoea 10 3 7 ... ... ... ... ... 10 ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... 5 ... ... ... ... 1 ... ... ... ... 1 Tuberculosis, Pulmonary 42 1 4 11 10 14 2 15 7 5 14 1 6 ... ... 4 ... 12 „ Non-Pulmonary 8 ... 2 5 ... 1 ... ... 3 1 ... 4 ... 1 ... ... ... ... 1 Pneumonia, Acute Primary, or Acute Influenzal 41 2 13 12 5 4 4 1 13 9 5 14 ... 6 2 2 4 ... 14 Totals 1032 41 355 504 56 43 '26 7 453 265 133 171 10 146 83 51 65 4 349 (h) Cases of Infectious Drease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Diseases notified during the 13 weeks ending 30th June, 1928. Notified Diseases Cases Notified in Whole Districts. Total Cases Notified in each Locality. Number of Cases Removed to hospital from each locality. At all Ages. Under 1 At Ages—Years. Greenwich East Greenwich West St. Nicholas. Deptford. Chariton. Kidbrooke. (h) Greenwich East Greenwich West St. Nicholas, Deplfonl. Chart tea. Kidbrooke. (h) Total. 1 to 5 5 to 15 15 to 25 26 to 45 45 to 65 65 and upwards Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 147 11 39 76 12 8 2 ... 64 32 16 31 4 63 31 15 31 4 144 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 15 ... 1 1 ... 3 6 ... 7 6 1 1 ... 3 1 ... ... ... 4 Scarlet Fever 98 1 17 68 7 4 1 ... 39 32 10 14 3 39 32 10 14 3 98 Membranous Croup 12 2 ... ... ... ... ... ... ... 2 ... ... ... ... 2 ... ... 2 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 1 ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2081 52 918 1082 21 8 ... ... 1012 489 125 446 9 56 58 11 13 4 142 Whooping Cough 118 13 59 41 ... ... ... ... 17 81 5 10 ... 1 20 ... ... ... 21 Diarrhoea 10 5 5 ... ... ... ... ... 8 ... ... 2 ... ... ... ... ... ... ... Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... 1 1 1 2 1 ... 1 ... 1 ... 2 Tuberculosis, Pulmonary 41 ... ... 4 13 16 8 ... 22 8 2 8 1 4 1 ... 1 ... 6 „ Non-Pulmonary 11 ... 5 3 2 1 ... ... 4 4 1 2 ... 2 2 1 ... ... 5 Pneumonia, Acute Primary, or Acute Influenzal 49 ... 9 16 7 9 7 1 11 17 7 13 1 5 ... 2 5 ... 19 Totals •2575 88 1055 1290 64 49 24 5 1186 670 170 530 19 174 153 41 66 11 445 (H) Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ending 29th Sept. 1928. Notifiable Diseases. Cases Notified in Whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each Locality. At all Ages. Under 1 1 to 0 At Ages—Years. Greenwich East Greenwich West St. Nicholas, Deptford. Charlton. Kidbrooke. (h) Greenwich East Greenwich West St. Nicholas, Deptford. Charlton. Kidbrooke. (h) Total. 5 to 15 15 to 25 .23 to 45 45 to 65 65 and upwards Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 89 1 28 43 11 6 ... ... 40 12 9 25 3 40 12 9 25 2 88 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 16 1 1 ... 2 3 9 ... 5 5 4 2 ... ... 2 2 ... ... 4 Scarlet Fever 71 ... 14 43 8 6 ... ... 35 12 8 13 3 35 12 8 13 3 71 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 5 ... ... ... 3 1 1 ... 3 2 ... ... ... 5 2 ... ... ... 5 Puerperal Pyrexia 2 ... ... ... ... 2 ... ... ... ... ... ... 2 ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Cerebo-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 204 10 90 98 6 ... ... ... 93 25 9 72 5 15 ... ... ... ... 16 Whooping Cough 100 13 58 27 1 1 ... ... 21 28 8 42 1 3 6 1 4 ... 14 Diarrhoea 71 35 36 ... ... ... ... ... 26 8 19 18 ... 1 1 5 ... ... 7 Ophthalmia Neonatorum 5 5 ... ... ... ... ... ... 1 1 I 2 ... ... ... ... ... ... ... Tuberculosis, Pulmonary 39 ... 1 1 12 17 6 2 9 17 6 7 ... ... 8 5 ... ... 12 „ Non-Pulmonary 11 ... ... 4 3 1 2 1 4 4 l 2 ... 3 3 1 2 ... 9 Pneumonia, Acute Primary, or Acute Influenzal 14 ... 1 1 4 2 5 1 5 4 I 4 ... ... 2 1 1 ... 4 Totals 628 65 229 217 50 40 28 4 242 118 66 188 14 100 48 32 45 5 230 (H) Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ending 29th Dec., 1928. Notified Diseases. Cases Notified in Whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. Greenwich East Greenwich West St. Nicholas, 1 Deptford. 1 Charlton. Kidbrooke. (h) Greenwich East Greenwich West St. Nicholas, Deptford. Charlton. Kidbrooke. (h) Total. Under 1 1 to 5 5 to 15 15 to 25 26 to 46 45 to 65 65 an.) upwards Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 89 2 28 48 8 3 ... ... 43 13 9 22 2 43 13 9 22 ... 88 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 19 ... ... ... 4 3 9 3 12 3 2 2 ... 6 2 2 ... ... 10 Scarlet Fever 102 18 66 13 4 1 ... 54 20 11 12 5 53 20 11 11 ... 100 Membranous Croup 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 Enteric Fever 3 ... 1 1 1 ... ... 1 2 ... ... ... 1 2 ... ... ... 3 Continued Fever ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... Cerebo-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 38 4 13 20 1 ... ... ... 19 3 ... 15 1 2 1 ... 1 ... 5 Whooping Cough 259 37 132 90 ... ... ... ... 129 8 26 90 6 ... 4 4 1 ... 9 Diarrhoea 13 8 5 ... ... ... ... ... 11 ... 2 ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Tuberculosis, Pulmonary *38 ... ... 2 13 14 8 ... 11 11 ... 15 1 5 1 ... 2 ... 8 „ Non-Pulmonary 7 1 1 3 1 1 ... ... 4 1 1 1 ... 2 ... ... ... ... 2 Pneumonia, Acute Primary, or Acute Influenzal 27 2 3 3 2 6 6 5 11 6 3 6 1 2 2 1 6 ... 11 Totals 597 55 201 233 43 32 24 9 296 68 54 163 16 114 47 27 43 6 237 (H) Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. * Includes 2 notifications dated 31/12/28. BOROUGH OF GREENWICH. Cases of Infectious Diseases notified during the 52 weeks ended 29th Dec., 1928. Notified Diseases. Cases Notified in Whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from Each Localiv. At all Ages. At Ages—Years. Greenwich East Greenwich West St. Nicholas, Deptford. j Charlton. Kidbrooke. (h) Greenwich East Greenwich West St. Nicholas, Deptford. Charlton. Kidbrooke. (h) Total. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... Polio Myelitis 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Diphtheria 464 18 136 244 40 24 2 ... 212 89 52 102 9 211 88 51 102 7 459 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 73 1 2 2 9 17 31 11 31 5 14 12 1 12 6 6 ... 1 25 Scarlet Fever 376 2 71 243 40 18 2 ... 171 86 41 66 12 167 86 41 65 12 371 Membranous Croup 4 ... 4 ... ... ... ... ... ... 1 3 ... ... ... 1 3 ... ... 4 Enteric Fever 12 ... ... 2 6 2 2 ... 5 6 ... ... 1 5 6 ... ... 1 11 Puerperal Pyrexia 4 ... ... ... 2 2 ... ... 1 ... ... 1 2 1 ... ... 1 ... 2 Puerperal Fever 5 ... ... ... 10 1 4 ... ... ... 13 ... 2 ... ... 3 ... 1 ... 4 Cerebo-Spinal Fever 2 ... ... 2 ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... 2 Malaria l ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... Measles 2934 86 1271 1525 40 13 ... ... 1396 693 217 607 21 94 79 27 18 6 223 Whooping Cough 506 69 267 168 1 1 ... ... 184 127 41 147 7 4 31 5 5 ... 45 Diarrhoea 104 51 53 ... ... ... ... ... 55 8 21 20 ... 1 1 5 ... ... 7 Ophthalmia Neonatorum 18 18 ... ... ... ... ... ... 8 3 2 4 1 1 11 ... 1 ... 3 Tuberculosis, Pulmonary •160 ... 2 11 49 57 36 5 57 43 13 44 3 15 12 5 7 ... 39 „ Non-Pulmonary 37 1 8 15 6 4 2 1 15 10 3 9 ... 8 5 2 2 ... 17 Pneumonia, Acute Primary, or Acute Influenzal 131 4 26 32 18 21 22 8 40 36 16 37 2 13 13 6 16 ... 48 Totals 4832 249 1840 2244 213 164 97 25 2177 1121 423 1052 59 534 331 151 219 26 1261 (H) Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. * Includes 2 notifications dated 31/12/28. BOROUGH OF GREENWICH. INFANTILE MORTALITY DURING THE YEAR 1928. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Week 1—2 Weeks 2—3 Weeks 3—4 Weeks Total under I Month 1—3 Months 3—6 Months 1 6—9 Months 9—12 Months Total Deaths under 1 Year Common Infectious Diseases. Small-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 2 ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 1 1 ... 3 Diphtheria—Croup ... ... ... ... ... 1 1 2 ... 4 Erysipelas ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis... ... ... ... ... ... ... ... ... ... ... Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis {not Tuberculous) ... ... ... ... ... ... ... ...... ... ... Convulsions ... 1 ... ... 1 2 ... 2 ... 5 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 2 1 ... 3 Pneumonia, all forms ... ... ... ... ... 3 2 6 2 13 Diarrhoeal Diseases. Diarrhoea, all forms ... ... ... ... ... ... 1 1 2 Enteritis ... ... ... 1 1 1 3 1 1 7 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... ... ... 2 ... ... 2 „ otherwise ... 1 ... ... ... 1 ... ... ... 1 2 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Actelectasis ... ... ... ... 1 ... ... ... ... 1 Congenital Malformations 2 ... ... ... 2 ... ... ... ... 2 Premature Birth 12 1 1 ... 15 3 ... ... ... 18 Atrophy, Debility and Marasmus 5 1 1 2 9 6 2 4 ... 21 Other Causes 2 ... ... ... 2 2 3 1 1 9 Totals 23 3 3 i 33 19 17 19 7 95 Boys 59 Birth Registered-( Legitimate)1639 Girls (IIIegitimate)62 Deaths Registered—Infants (Legitimate) 89 (Illegitimate)